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HABITS 
THAT  HANDICAP 


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HABITS 
THAT  HANDICAP 

The  Menace  of  Opium,  Alcohol,  and  Tobacco, 
and  the  Remedy 

BY 

CHARLES  B.  TOWNS 


NEW  YORK 
THE  CENTURY  CO. 

1916 


■    \ 

Copyright,  1915,  by 
The  Centuhy  Co. 

Published,  August,  1915 


PREFACE 

It  is  interesting  to  note  that  a  year  or  more 
ago  a  few  deaths  from  bichlorid  of  mercury 
poisoning  caused  within  a  period  of  six  months 
a  general  movement  toward  protective  legisla- 
tion. This  movement  was  successful,  and  after 
the  lapse  of  only  a  short  time  the  public  was 
thoroughly  protected  against  this  dangerous 
poison.  It  will  be  observed  that  the  financial 
returns  from  the  total  sale  of  bichlorid  of  mer- 
cury tablets  could  be  but  small.  Had  the 
financial  interests  involved  been  of  a  magnitude 
comparable  with  those  interested  in  the  manu- 
facture and  promotion  of  habit-forming  drugs,  I 
have  often  wondered  if  the  result  would  not  have 
been  less  effective  and  as  prompt.  Bichlorid  of 
mercury  never  threatened  any  large  proportion 
of  the  public,  and  those  falling  victims  to  it 
merely  die.  Opium  and  its  derivatives  threaten 
the  entire  public,  especially  those  who  are  sick 
and  in  pain,  and  with  a  fate  far  more  terrible 
than  death — a  thraldom  of  misery,  inefficiency, 
and  disgrace. 


vi  PREFACE 

Lest  somewHere  there  be  found  witliin  tHe 
pages  of  this  book  remarks  that  may  lead  the 
reader  to  suppose  that  I  unduly  criticize  the 
doctor,  and  therefore  that  I  am  the  doctor's 
enemy,  I  feel  that  it  behooves  me  to  add  that  in 
the  whole  community  he  has  not  one  admirer 
more  whole-souled. 


PEEFACE 

Some  years  ago,  Mr.  Charles  B.  Towns  came 
to  me  with  a  letter  from  Dr.  Alexander  Lambert 
and  claimed  that  he  had  a  way  of  stopping  the 
morphia  habit.  The  claim  seemed  to  me  an  en- 
tirely impossible  statement,  and  I  told  Mr. 
Towns  so;  but  at  Dr.  Lambert's  suggestion,  I 
promised  to  look  into  the  matter.  Accordingly, 
I  visited  Mr.  Towns's  hospital,  and  watched  the 
course  of  treatment  there  at  different  times  in 
the  day  and  night.  I  became  convinced  that  the 
withdrawal  of  morphine  was  accomplished  un- 
der this  treatment  with  vastly  less  suffering 
than  that  entailed  by  any  other  treatment  or 
method  I  had  ever  seen.  Subsequently,  I  sent 
Mr.  Towns  several  patients,  who  easily  and 
quickly  were  rid  of  their  morphia  addiction,  and 
have  now  remained  well  for  a  number  of  years. 

At  that  time  I  had  the  impression  that  the 
treatment  was  largely  due  to  the  force  of  Mr. 
Towns's  very  vigorous  and  helpful  personality, 
but  when  subsequently  a  similar  institution  was 
established  near  Boston,  I  became  convinced  by 

vU 


viii  PREFACE 

observation  of  cases  treated  in  that  hospital  that 
Mr.  Towns's  personality  was  not  an  essential 
element  in  that  treatment.  His  skill,  however, 
in  the  actual  management  of  cases,  from  the 
medical  point  of  view,  was  very  hard  to  dupli- 
cate, and  Mr.  Towns  generously  came  from  New 
York,  when  called  upon,  and  showed  us  what  was 
wrong  in  the  management  of  cases  which  were 
not  doing  well.  I  do  not  hesitate  to  say  that  he 
knows  more  about  the  alleviation  and  cure  of 
drug  addictions  than  any  doctor  that  I  have  ever 
seen. 

All  the  statements  made  in  this  book  except 
those  relating  to  tobacco  I  can  verify  from  sim- 
ilar experiences  of  my  own,  since  I  have  known 
and  used  Mr.  Towns's  method  of  treatment. 

I  do  not  pretend  to  say  how  his  treatment 
accomplishes  the  results  which  I  have  seen  it 
accomplish,  but  I  have  yet  to  learn  of  any  one 
who  has  given  it  a  thorough  trial  who  has 
obtained  results  differing  in  any  considerable 
way  from  those  to  which  Mr.  Towns  refers. 

The  wider  applications  and  generalizations  of 
the  book  seem  to  me  very  instructive.  The 
shortcomings  of  the  medical  profession,  of  the 
druggists,  and  those  who  have  to  do  with  the 
management  of  alcoholics  in  courts  of  law  seem 


PKEFACE  ix 

to  me  well  substantiated  by  the  facts.  Mr. 
Towns's  plans  for  legislative  control  of  drug 
habits  also  seem  to  me  wise  and  far-reacbing. 
He  is,  I  believe,  one  of  the  most  public-spirited 
as  well  as  one  of  the  most  honest  and  forceful 
men  that  I  have  ever  known. 

I  am  glad  to  have  this  opportunity  of  express- 
ing my  faith  and  confidence  in  him  and  my  sense 
of  the  value  of  the  book  he  has  written. 

EiCHABD  C.  Cabot. 


INTRODUCTION 

There  is  only  one  way  by  means  of  which 
humanity  can  be  relieved  of  the  curse  of  drug 
using,  and  that  is  to  adopt  methods  putting  the 
entire  responsibility  upon  the  doctor.  Until  the 
present  legislation  was  passed  in  New  York 
State,  no  one  had  ever  considered  the  doctor's 
responsibility;  this  most  valuable  medical  asset 
and  most  terrible  potential  curse  had  been  virtu- 
ally without  safeguard  of  any  effective  kind. 
Discussion  of  the  drug  problem  in  the  press 
dealt  wholly  with  those  phases  which  make 
themselves  manifest  in  the  underworld  or  among 
the  Chinese.  I  am  reasonably  certain  that  until 
very  recently  the  world  had  heard  nothing  of 
the  blameless  men  and  women  who  had  become 
drug-users  as  the  result  of  illness.  This  seems 
strange,  since  there  are  in  the  United  States 
more  victims  of  the  drug  habit  than  there  are  of 
tuberculosis.  It  is  estimated  that  fifteen  per 
cent,  of  the  practising  physicians  in  the  country 
are  addicted  to  the  habit,  and  although  I  think 
this  is  an  exaggeration,  it  is  nevertheless  true 


xii  INTEODUCTION 

that  habit-forming  drugs  demand  a  heavy  toll 
from  the  medical  profession,  wrecking  able 
practitioners  in  health  and  reputation,  and  of 
course  seriously  endangering  the  public. 

I  have  elsewhere  explained  the  fact  that  the 
medical  man  himself  is  ignorant  of  the  length 
to  which  he  can  safely  go  in  the  administration 
of  drugs  to  his  patients.  If  he  is  ignorant  of 
what  quantity  and  manner  of  dosage  constitutes 
a  peril  for  the  patient,  is  it  not  reasonable  to 
suppose  that  similar  ignorance  exists  in  his 
mind  with  regard  to  his  own  relations  with  the 
drug  habit?  As  a  matter  of  fact,  I  know  this  to 
be  the  case ;  many  physicians  have  come  to  me 
for  help,  and  ninety-nine  per  cent,  of  them  ex- 
plained to  me  that  their  use  of  drugs  was  the 
direct  outgrowth  of  their  ignorance.  If  the  man 
who  practises  medicine  is  unaware  of  what  will 
bring  about  the  habit,  what  can  be  expected  of 
the  medically  uneducated  citizen  who  is  threat- 
ened by  those  in  whom  he  has  most  confidence — 
his  doctors? 

The  wide  extent  of  the  drug  habit  in  this  coun- 
try has  not  been  apparent.  The  man  suffering 
from  a  physical  disease  either  shows  it  or  makes 
it  known ;  the  man  suffering  from  the  drug  habit 
presents  unfamiliar  and  unidentified  symptoms, 


INTRODUCTION  xiii 

and  far  from  being  willing  to  make  his  affliction 
known,  through  shame  he  tries  to  conceal  it  at 
all  hazards.  Until  legislation  forced  the  victims 
of  drug  habits  by  hundreds  into  Bellevue  Hospi- 
tal in  New  York,  this  great  institution  rarely- 
had  one  as  a  patient.  The  sufferer  from  tuber- 
culosis would  seek  this  hospital,  feeling  that 
there  he  might  find  measurable  relief ;  the  drug- 
user  shunned  it,  for  he  was  doubtful  of  receiving 
aid,  and  above  all  things  he  dreaded  depriva- 
tion without  relief.  No  man  or  woman  will  go 
to  any  institution  for  relief  from  the  drug  habit 
where  the  only  treatment  offered  is  that  of  en- 
forced deprivation,  for  he  or  she  knows  per- 
fectly well  that  deprivation  means  death.  No 
human  longing  can  compare  in  intensity  with 
that  of  the  drug-user  for  his  drug.  Unrelieved, 
he  will  let  nothing  stand  between  him  and  it; 
neither  hunger,  nakedness,  starvation,  arson, 
theft,  nor  murder  will  keep  him  from  the  sub- 
stance that  he  craves.  Clearly  humanity  must 
be  protected  against  such  an  evil.  And  the  phy- 
sician must  be  saved  from  it,  for  saving  him  will 
fulfil  in  a  large  measure  the  demand  for  the  pro- 
tection of  the  public. 

After  the  experience  of  the  medical  profes- 
sion of  New  York  State  with  the  workings  of  the 


xiv  INTRODUCTION 

Boylan  Act,  it  is  scarcely  probable  tbat  strong 
opposition  to  similar  legislation  will  be  made  in 
other  States.  Even  if  other  States  delay  in  the 
enactment  of  right  legislation,  the  Boylan  Act 
may  be  considered  not  only  a  protective  measure 
for  the  profession  and  the  people  of  New  York 
State,  but  it  may  be  safely  accepted  as  an  educa- 
tional pronouncement  for  the  benefit  of  the  med- 
ical profession  everywhere.  It  establishes  for 
the  first  time  the  danger-line. 


CONTENTS 


OHAPTEB  FAGB 

I     THE  PERIL  OF  THE  DRUG  HABIT 3 

II     THE    NEED    OP    ADEQUATE    SPECIFIC    TREATMENT 

FOR  THE  DRUG-TAKER 27j 

III  THE  DRUG-TAKER  AND  THE  PHYSICIAN   ....     46 

IV  PSYCHOLOGY  AND   DRUGS 61 

V    ALCOHOLICS 76 

VI     HELP  FOR  THE  HARD  DRINKER 87 

VII     CLASSIFICATION  OF  ALCOHOLICS 113 

VIII     THE  INJURIOUSNESS  OP  TOBACCO 140 

IX     TOBACCO  AND  THE  FUTURE  OF  THE  RACE     .      .      .162 

X     THE  SANATORIUM 174 

XI     PREVENTIVE  MEASURES  FOR  THE  DRUG  EVIL   .      .    194 
XII     CLASSIFICATION  OF  HABIT-FORinNG  DRUGS     .      .  215 

XIII     PSYCHOLOGY  OP  ADDICTION 227 

APPENDIX        .      .      .      .     1.      .      .     t.i    >    M    I.!     w.     .   285 


HABITS  THAT  HANDICAP 


HABITS  THAT  HANDICAP 

CHAPTER  I 

THE   PEKIL   OF   THE  DEUG  HABIT 

IT  is  human  nature  to  wish  to  ease  pain  and 
to  stimulate  ebbing  vitality.  There  is  no 
normal  adult  who,  experiencing  severe  pain  or 
sorrow  or  fatigue,  and  thoroughly  appreciating 
the  immediate  action  of  an  easily  accessible 
opiate,  is  not  likely  in  a  moment  of  least  resist- 
ance to  take  it.  Every  one  who  has  become 
addicted  to  a  drug  has  started  out  with  small 
occasional  doses,  and  no  one  has  expected  to  fall 
a  victim  to  the  habit;  indeed,  many  have  been 
totally  unaware  that  the  medicine  they  were 
taking  contained  any  drug  whatever.  Thus,  the 
danger  being  one  that  threatens  us  all,  it  is 
every  man's  business  to  insist  that  the  entire 
handling  and  sale  of  the  drug  be  under  as  care- 
ful supervision  as  possible.  It  is  not  going  too 
far  to  say  that  up  to  the  present  time  most  drug- 
takers  have  been  unfairly  treated  by  society. 

3 


4  HABITS  THAT  HANDICAP 

They  have  not  been  properly  safeguarded  from 
forming  the  habit  or  properly  helped  to  over- 
come it. 

It  has  been  criminally  easy  for  any  one  to 
acquire  the  drug  habit.  Few  physicians  have 
recognized  that  it  is  not  safe  for  most  persons  to 
know  what  will  ease  pain.  When  an  opiate  is 
necessary,  it  should  be  given  only  on  prescrip- 
tion, and  its  presence  should  then  be  thoroughly 
disguised.  A  patient  goes  to  a  physician  to  be 
cured;  consequently,  when  his  pain  disappears, 
he  naturally  believes  that  this  is  due  to  the  treat- 
ment he  has  received.  If  the  physician  has  used 
morphine  in  a  disguised  form,  the  patient  natu- 
rally believes  that  the  cure  was  effected  by  some 
unknown  medicine ;  but  if,  on  the  other  hand,  he 
has  received  morphine  knowingly,  he  realizes  at 
once  that  it  is  this  drug  which  is  responsible  for 
easing  his  pain.  If  he  has  received  it  hypo- 
dermically,  the  idea  is  created  in  his  mind  that  p 
hypodermic  is  a  necessary  part  of  the  treatment. 
Thus  it  is  clear  that  the  physician  who  uses  his 
syringe  without  extreme  urgency  is  greatly  to 
be  censured,  for  the  patient  who  has  once  seen 
his  pain  blunted  by  the  use  of  a  hypodermic 
eagerly  resorts  to  this  means  when  the  pain  re- 
turns.   Conservative  practitioners  are  keenly 


THE  PERIL  OF  THE  DEUG  HABIT  5 

aware  of  this  responsibility,  and  some  go  so  far 
as  never  to  carry  a  hypodermic  on  their  visits, 
though  daily  observation  shows  that  the  average 
doctor  regards  it  as  indispensable.  The  con- 
servative physician  employs  only  a  very  small 
quantity  of  morphine  in  any  form.  One  of  the 
busiest  and  most  successful  doctors  of  my  ac- 
quaintance has  used  as  little  as  half  a  grain  a 
year,  and  another  told  me  he  had  never  gone 
beyond  two  grains. 

Both  of  these  men  know  very  well  that  only  a 
small  percentage  of  drug-takers  have  begun  the 
practice  in  consequence  of  a  serious  ailment,  and 
that  even  this  small  percentage  might  have  been 
decreased  by  proper  medical  treatment  directed 
at  the  cause  rather  than  at  its  symptom,  pain. 
An  opiate,  of  course,  never  removes  the  cause 
of  any  physical  trouble,  but  merely  blunts  the 
pain  due  to  it ;  and  it  does  this  by  tying  up  the 
functions  of  the  body.  It  is  perhaps  a  conserv- 
ative estimate  that  only  ten  per  cent,  of  the 
entire  drug  consumption  in  this  country  is  ap- 
plied to  the  purpose  of  blunting  incurable  pain. 
Thus  ninety  per  cent,  of  the  opiates  used  are, 
strictly  speaking,  unnecessary.  In  the  innumer- 
able cases  that  have  come  under  my  observation, 
seventy-five  per  cent,  of  the  habitual  users  be- 


6  HABITS  THAT  HANDICAP 

came  such  without  reasonable  excuse.  Begin- 
ning with  small  occasional  doses,  they  realized 
within  a  few  weeks  that  they  had  lost  self- 
control  and  could  not  discontinue  the  use  of  the 
drug. 

FORMING  THE  HABIT 

A  very  common  source  of  this  habit  lies  in 
the  continued  administration  of  an  opiate  in  reg- 
ular medical  treatment  without  the  patient  *s 
knowledge  or  consent,  or  in  the  persistent  use  of 
a  patent  medicine,  or  of  a  headache  or  catarrh 
powder  that  contains  such  a  drug. 

The  man  who  takes  an  opiate  consciously  or 
unconsciously,  and  receives  from  it  a  soothing 
or  stimulating  or  pleasant  effect,  naturally  turns 
to  it  again  in  case  of  the  same  need.  The  time 
soon  arrives  when  the  pleasurable  part  of  the 
effect — if  it  was  ever  present — ceases  to  be  ob- 
tained ;  and  in  order  to  get  the  soothing  or  stim- 
ulating effect,  the  dose  must  be  constantly 
increased  as  tolerance  increases.  With  those 
who  take  a  drug  to  blunt  a  pain  which  can 
be  removed  in  no  other  way,  it  is  fulfilling  its 
legitimate  and  supreme  mission  and  admits  of 
no  substitute.  Where  it  was  ever  physically 
necessary,  and  that  necessity  still  continues,  an 


THE  PERIL  OF  THE  DRUG  HABIT  7 

opiate  would  seem  inevitable.  But  the  percent- 
age of  such  sufferers,  as  I  have  said,  is  small. 
The  rest  are  impelled  simply  by  craving — that 
intolerable  craving  which  arises  from  depriva- 
tion of  the  drug. 

But  whether  a  man  has  acquired  the  habit 
knowingly  or  unknowingly,  its  action  is  always 
the  same.  No  matter  how  conscientiously  he 
wishes  to  discharge  his  affairs,  the  drug  at  once 
begins  to  loosen  his  sense  of  moral  obligation, 
until  in  the  end  it  brings  about  absolute  irre- 
sponsibility. Avoidance  and  neglect  of  custom- 
ary duties,  evasion  of  new  ones,  extraordinary 
resourcefulness  in  the  discovery  of  the  line  of 
least  resistance,  and  finally  amazing  cunning 
and  treachery — this  is  the  inevitable  history. 

The  drug  habit  is  no  respecter  of  persons.  I 
have  had  under  my  care  exemplary  mothers  and 
wives  who  became  indifferent  to  their  families ; 
clergymen  of  known  sincerity  and  fervor  who 
became  shoplifters  and  forgers;  shrewd,  suc- 
cessful business  men  who  became  paupers,  be- 
cause the  habit  left  them  at  the  mercy  of  sharp- 
ers after  mental  deterioration  had  set  in.  But 
the  immediate  action  of  morphine  by  no  means 
paralyzes  the  mental  faculties.  Though  when 
once  a  man  becomes  addicted  to  the  drug  he  is 


8  HABITS  THAT  HANDICAP 

incapacitated  to  deal  with  himself,  yet  while  he 
is  under  its  brief  influence  his  mind  is  sharp- 
ened and  alert.  Under  the  sway  of  opium  a 
man  does  venturesome  or  immoderate  things 
that  he  would  never  think  of  doing  otherwise, 
simply  because  he  has  lost  the  sense  of  responsi- 
bility. I  have  had  patients  who  took  as  much  as 
sixty  grains  of  morphine  in  a  single  dose,  an 
overdose  for  about  one  hundred  and  fifty  people, 
and  about  fifty  grains  more  than  the  takers 
could  possibly  assimilate  or  needed  to  produce 
the  required  result — an  excellent  illustration  of 
how  the  habit  destroys  all  judgment  and  all 
sense  of  proportion. 

Against  this  appalling  habit,  which  can  be  ac- 
quired easily  and  naturally  and  the  result  of 
which  is  always  complete  demoralization,  there 
is  at  present  no  effective  safeguard  except  that 
provided  by  nature  itself,  and  this  is  effective 
only  in  certain  cases.  It  happens  that  in  many 
people  opium  produces  nausea,  and  this  one 
thing  alone  has  saved  some  from  the  habit ;  for 
this  type  of  user  never  experiences  any  of  the 
temporarily  soothing  sensations  commonly  at- 
tributed to  the  drug.  Yet  this  pitiful  natural 
safeguard,  while  rarely  operative,  is  more  ef- 
ficacious than  any  other  that  up  to  the  present 


JHE  PERIL  OF  THE  DRUa  HABIT  9 

has  been  provided  by  man  in  Ms  heedlessness, 
indifference,  and  greed. 

DANGERS  OP  THE  HYPODERMIC   SYRINGE 

I  have  seen  over  six  thousand  cases  of  drug 
habit  in  various  countries  of  the  world.  Ninety- 
five  per  cent,  of  the  patients  who  have  come  to 
me  taking  morphine  or  other  alkaloids  of  opium 
have  taken  the  drug  hypodermically.  "With  few 
exceptions,  I  have  found  that  the  first  knowledge 
of  it  came  through  the  administration  of  a  hypo- 
dermic by  a  physician.  It  is  the  instrument 
used  that  has  shown  the  sufferer  what  was 
easing  his  pain.  I  consider  that  among  those 
who  have  acquired  the  habit  through  sickness 
or  injury  this  has  been  the  chief  creator  of  the 
drug  habit.  This  statement  does  not  apply  to 
those  who  have  acquired  the  habit  through  the 
taking  of  drugs  otherwise.  My  work  has  been 
carried  out  almost  entirely  in  cooperation  with 
the  physician,  and  I  have  not  come  in  contact 
with  the  under-world  drug-takers.  I  consider 
that  the  syringe  has  been  the  chief  creator  of 
the  drug  habit  in  this  country.  In  1911 1  made 
this  statement  before  the  Ways  and  Means  Com- 
mittee of  the  United  States  Congress,  then  oc- 
cupied with  the  matter  of  regulating  the  sale  of 


10  HABITS  THAT  HANDICAP 

habit-forming  drugs,  and  I  personally  secured 
tlie  act  which  was  passed  by  the  New  York  legis- 
lature in  February,  1911,  to  restrict  the  sale  of 
this  instrument  to  buyers  on  a  physician's  pre- 
scription. Before  that  time  all  drug  stores  and 
most  department  stores  sold  hypodermic  instru- 
ments to  any  one  who  had  the  money.  A  boy  of 
fifteen  could  buy  a  syringe  as  easily  as  he  could 
buy  a  jack-knife.  If  a  physician  refused  to  give 
an  injection,  the  patient  could  get  an  instrument 
anywhere  and  use  it  on  himself.  This  biU  has 
passed  only  a  single  legislature,  but  I  am  ar- 
ranging to  introduce  a  similar  biU  before  all  the 
others,  and  hope  to  have  the  State  action  con- 
firmed by  a  Federal  bill.  At  present  in  Jersey 
City,  or  anywhere  out  of  New  York,  any  one 
may  still  buy  the  instrument.  It  is  inconceiv- 
able that  the  syringe  should  have  gone  so  long 
without  being  considered  the  chief  factor  in  the 
promotion  of  a  habit  which  now  alarms  the 
world,  and  that  as  yet  only  one  state  legislature 
should  have  seen  fit  to  regulate  its  sale.  Ee- 
stricting  the  sale  of  the  syringe  to  physicians, 
or  to  buyers  on  a  physician's  prescription,  is  the 
first  step  toward  placing  the  grave  responsibil- 
ity for  the  drug  habit  on  the  shoulders  of  those 
to  whom  it  belongs. 


THE  PERIi;  OF  THE  DRUa  HABIT    11 

HABIT-FOBMING  DRUGS  IN   PATENT   MEDICINES 

The  second  step  to  be  taken  is  to  prevent  by 
law  the  use  of  habit-forming  drugs  in  patent  and 
proprietary  medicines  which  can  be  bought 
without  a  physician's  prescription.  Prior  to 
the  Pure  Food  and  Drugs  Act,  created  and  pro- 
moted by  Dr.  H.  W.  Wiley,  druggists  and 
patent-medicine  venders  were  able,  without  an- 
nouncing the  fact,  to  sell  vast  quantities  of  habit- 
forming  drugs  in  compounds  prepared  for 
physical  ailments.  When  that  act  came  into 
effect,  these  men  were  obliged  to  specify  on  the 
label  the  quantities  of  such  drugs  used  in  these 
compounds,  and  thus  the  purchaser  was  at  least 
enabled  to  know  that  he  was  handling  a  danger- 
ous tool.  Except  in  a  few  States,  however,  the 
sale  of  these  compounds  was  in  no  way  re- 
stricted, and  hence  the  act  cannot  be  said  to  have 
done  much  toward  checking  the  formation  of  the 
drug  habit.  Indeed,  it  has  probably  worked  the 
other  way,  for  there  is  perhaps  not  an  adult  liv- 
ing who  does  not  know  that  certain  drugs  will 
alleviate  pain,  and  people  who  have  pains  and 
aches  are  likely  to  resort  to  an  accessible  and 
generally  accredited  means  of  alleviation.  Yet 
the  difficulties  in  the  way  of  passing  the  Pure 


12  HABITS  THAT  HANDICAP 

Food  and  Drugs  Act  are  a  matter  of  scandalous 
history.  What,  then,  would  be  the  difficulties 
in  passing  a  Federal  bill  to  restrict  the  sale  of 
patent  medicines  containing  habit-forming 
drugs?  It  is  of  course  to  the  interest  of  every 
druggist  to  create  a  lasting  demand  for  his 
article.  There  is  obviously  not  so  much  profit 
in  a  medicine  that  cures  as  in  one  that  becomes 
indispensable.  Hence  arises  the  great  induce- 
ment, from  the  druggist's  point  of  view,  in 
soothing- syrups  and  the  like.  In  this  country 
all  druggists,  wholesale  and  retail,  are  organ- 
ized, and  the  moment  a  bill  is  brought  up  any- 
where to  correct  the  evil  in  question,  there  is 
enormous  pressure  of  business  interests  to  se- 
cure its  dismissal  or  satisfactory  amendment. 

To  show  the  essential  selfishness  of  their 
position,  it  is  only  necessary  to  quote  a  few  of 
the  arguments  used  against  me  before  the  Con- 
gressional Ways  and  Means  Committee  when  I 
was  making  a  plea  for  the  regulation  of  the  traf- 
fic in  habit-forming  drugs.  They  claimed  that 
registration  of  the  quantities  of  opiates  in  pro- 
prietary medicines  would  entail  great  bother 
and  added  expense,  that  these  drugs  are  usually 
combined  with  others  in  such  a  way  as  to  result 
in  altering  their  effect  on  the  user,  and  that,  any- 


THE  PERIL  OF  THE  DEUa  HABIT    13 

way,  so  small  an  amount  of  these  drugs  is  used 
that  it  cannot  create  a  habit.  Now,  as  a  matter 
of  fact,  the  combination  of  medicines  in  these 
remedies  makes  not  the  slightest  difference  in 
the  physiological  action  of  the  drug ;  further,  it 
is  found  that,  just  as  With  the  drug  itself,  the 
dose  of  these  compounds  must  be  constantly  in- 
creased in  order  to  confer  the  same  apparent 
benefit  as  in  the  beginning;  and  finally,  it  is  well 
known  that  what  creates  the  craving  is  not  the 
quantity  of  the  drug,  but  the  regularity  with 
which  it  is  taken.  A  taker  of  one  eighth  of  a 
grain  of  morphine  three  times  a  day  would  ac- 
quire the  habit  just  as  surely  as  a  man  who  took 
three  grains  three  times  a  day,  provided  the 
latter  could  tolerate  that  quantity. 

The  average  opium-smoker  consuming  twenty- 
five  pills  a  day  gets  only  the  equivalent  of  about 
a  quarter  grain  of  morphine  taken  hypodermi- 
cally  or  of  a  half  grain  taken  by  the  mouth.  A 
beginner  could  not  smoke  a  quarter  of  that 
quantity,  but  still  he  acquires  the  habit.  Any 
amount  of  the  drug  which  is  sufiicient  to  allevi- 
ate pain  or  make  the  taker  feel  easier  is  suf- 
ficient to  create  a  habit.  A  habit-forming  drug 
having  no  curative  properties  whatever  is  put 
into  a  medicine  merely  for  the  purpose  of  mak- 


14  HABITS  THAT  HANDICAP 

ing  the  taker  feel  easier.  One  wholesale  house 
alone  prepares  and  sells  six  hundred  remedies 
containing  some  form  of  opiate.  Most  of  the 
eases  of  the  cocaine  habit  have  been  admittedly 
created  by  so-called  catarrh  cures,  and  these 
contain  only  from  two  to  four  per  cent,  of  co- 
caine. In  the  end,  the  snuffer  of  catarrh  pow- 
ders comes  to  demand  undiluted  cocaine;  the 
taker  of  morphine  in  patent  medicines,  once  the 
habit  is  formed,  must  inevitably  demand  un- 
diluted morphine. 

This  easy  accessibility  of  drug-s  in  medic- 
inal form  is  more  dangerous  than  moralists 
care  to  admit.  The  reason  why  opium- 
smoMng  has  been,  up  to  the  present,  less  prev- 
alent in  the  United  States  than  in  China  and 
some  other  countries  is  probably  that  the 
preparation  of  it  and  the  machinery  for  taking 
it  are  not  convenient.  If  opium-smoMng  had 
been  generally  countenanced  in  America,  if 
the  sale  of  the  pure  drug  had  been  for  genera- 
tions permitted  here,  as  it  has  been  in  China, 
if  houses  for  its  sale  and  preparation  had 
been  found  everywhere,  if  its  social  aspects  had 
been  considered  agreeable,  if  society  had  put  the 
stamp  of  approval  upon  it,  opium-smoking 
would  be  as  prevalent  here  as  it  has  been  in 


THE  PERIL  OF  THE  DBUG  HABIT    15 

China.  Our  human  nature  is  essentially  little 
different  from  that  of  the  Chinese,  but  lack  of 
opportunity  is  everywhere  recognized  as  a  great 
preservative  of  virtue.  Due  allowance  being 
made  for  the  difference  of  moral  concepts,  our 
standards  of  morality  and  honesty  and  virtue 
are  certainly  no  higher  than  those  of  the  Chi- 
nese. Thus,  were  the  conditions  the  same  in 
both  cases,  there  is  no  reason  to  suppose  that 
opium  would  not  be  smoked  here  as  much  as 
there ;  but  fortunately  it  has  not  yet  become  thus 
easy,  convenient,  and  agreeable,  and  conse- 
quently that  particular  phase  of  the  evil  has  not 
yet  reached  overwhelming  proportions.  On  the 
other  hand,  the  alkaloids  of  opium  administered 
hypodermically  or  as  ingredients  in  many  patent 
medicines  are  thus  convenient,  and  as  a  result 
this  phase  of  the  evil  has  reached  overwhelming 
proportions.  Nor  have  we  any  cause  for  con- 
gratulation upon  our  particular  form  of  the 
vice,  for  opium-smoMng  is  vastly  less  vicious 
than  morphine-taking. 

THE  TEAPFIC  IN"   OPIUM 

Something  more  is  needed,  however,  than 
mere  restriction  of  the  sale  of  hypodermic 
syringes  and  patent  medicines  by  any  one  legis- 


16  HABITS  THAT  HANDICAP 

lature  or  country.  All  persons  who  handle 
habit-forming  drugs  should  be  made  to  give  a 
strict  accounting  for  them,  otherwise  the  trafl&c 
can  never  be  properly  regulated.  Four  years 
ago,  by  special  act  of  Congress,  all  importation 
of  prepared  opium  and  of  crude  opium  designed 
for  smoking  purposes  was  prohibited.  In  the 
ample  interval  between  the  passage  of  the  bill 
and  its  going  into  effect  the  importation  of  opium 
was  simply  phenomenal.  By  the  time  it  went 
into  effect  the  American  dealers  had  learned  the 
secret  process  of  preparing  opium  for  smoking, 
which  had  hitherto  been  known  only  in  the 
Orient.  Thereafter  it  was  found  that  since  re- 
sponsible importing  houses  were  still  at  liberty 
to  import  crude  opium  in  any  quantity  for  gen- 
eral medicinal  use,  the  retailers  could  buy  and 
were  buying  from  importers  aU  the  crude  opium 
they  wished  and  preparing  it  themselves  with- 
out having  in  any  way  to  account  for  the  use 
they  meant  to  make  of  it,  although  that  use  had 
now  become  illegal.  The  result  was  that  the 
smoker  could  get  opium  more  easily  than  before, 
since  the  secret  process  of  preparing  it  had  be- 
come known;  and  having  no  longer  to  pay  the 
enormous  tax  on  prepared  opium,  he  got  it  much 
cheaper.    In  short,  the  only  difference  was  that 


THE  PEEIL  OF  THE  DEUG  HABIT    17 

the  Goveriunent  lost  about  one  million  five  hun- 
dred thousand  dollars  a  year  in  revenue,  while 
the  vice  was  greatly  increased.  Thus  the  act 
had  worked  in  precisely  the  opposite  way  from 
the  intention  of  the  f  ramers,  and  all  because  men 
are  permitted  to  handle  opium  without  account- 
ing for  it.  Until  there  is  such  an  accounting, 
there  can  be  no  real  regulation  of  the  opium 
trade. 

Congress  has  just  passed  a  bill  aiming  to  reg- 
ulate the  traffic  in  habit-forming  drugs.  I  wish 
to  go  on  record  here  as  saying  that  this  bill  will 
not  accomplish  its  purpose,  and  should  be  fur- 
ther amended  to  prove  effective.  But  it  will  be 
only  a  matter  of  time  when  there  will  be  amend- 
ments proposed,  which,  if  adopted,  will  create 
legislation  on  this  subject  worth  while. 

The  history  of  the  Opium  Commission  ap- 
pointed by  Mr.  Taft  is  sufficient  to  show  how 
any  less  comprehensive  regulation  would  act. 
When  Mr.  Taft  was  Governor-General  of  the 
Philippines,  he  found  that  an  enormous  quantity 
of  opium  was  being  smoked  by  the  natives  and 
the  large  Chinese  settlement,  of  whom  it  was  es- 
timated that  fifty-five  thousand  were  smokers. 
He  appointed  a  commission  headed  by  Bishop 
Brent,  now  stationed  at  Manila,  who  has  since 


18  HABITS  THAT  HANDICAP 

headed  two  international  opium  conferences,  at 
Shanghai  in  1909  and  at  The  Hague  in  1911. 
Mr.  Taft  sent  the  commission  into  the  most  im- 
portant opium-producing  countries  to  find  out 
how  they  were  dealing  with  the  problem  and 
what  progress  was  being  made  toward  decreas- 
ing the  use  of  the  drug.  The  nearest  approach 
they  found  to  a  reform  was  the  method  of  the 
Japanese  in  their  newly  acquired  island  of  For- 
mosa. Japan,  with  the  most  stringent  regula- 
tion of  the  sale  of  opium  in  the  world,  had  made 
it  a  government  monopoly  in  Formosa,  had  com- 
pelled the  registration  of  all  smokers,  and  was 
gradually  lessening  the  amount  which  each 
smoker  could  buy.  After  the  exhaustive  report 
of  the  commission,  our  Government  adopted  the 
same  tactics  in  the  Philippines.  To  the  surprise 
of  the  officials,  they  found  that  out  of  the  fifty- 
five  thousand  opium-smokers  they  could  obtain  a 
registration  of  only  from  ten  to  twelve  thou- 
sand, which  meant  that  the  great  majority  were 
getting  smuggled  opium.  By  special  act  of  Con- 
gress the  authorities  at  Manila  were  allowed  to 
stop  the  importation  of  opium  entirely.  But 
this,  while  it  meant  a  great  loss  of  revenue  to  the 
local  government,  apparently  did  not  lessen  the 
amount  smoked.    After  the  sale  was  stopped, 


THE  PEEIL  OF  THE  DEUG  HABIT    19 

there  were  virtually  no  voluntary  applications 
for  opium  treatment,  as  there  must  have  been 
if  anybody's  supply  had  been  cut  off,  which  con- 
clusively showed  that  nobody  had  discontinued 
the  habit  merely  because  importation  had  been 
discontinued.  Stopping  importation,  then,  is  a 
farce,  unless  at  the  same  time  there  is  rigid  gov- 
ernmental control  in  those  countries  that  pro- 
duce or  import  the  drug.  And,  therefore,  un- 
less there  should  be  a  cooperation  of  all  govern- 
ments, it  is  futile  to  try  to  regulate  the  traffic. 
As  long  as  people  can  get  opium,  they  will 
smuggle  it. 

It  has  been  demonstrated  to  be  quite  practi- 
cable for  all  the  opium-producing  countries  to 
make  the  drug  a  government  monopoly ;  it  would 
be  equally  practicable  for  them  to  sell  directly 
to  those  governments  that  use  it  for  govern- 
mental distribution.  The  only  obstacle  to  an 
international  understanding  is  that  the  produc- 
ing countries  know  very  well  that  government 
regulation  would  materially  lessen  the  sale  of 
the  drug.  Within  the  borders  of  our  own  coun- 
try such  a  system  would  simplify  rather  than 
complicate  present  conditions.  We  have  to-day 
along  our  frontier  and  in  our  ports  inspectors 
trying  to  stop  the  illicit  traffic  in  opium,  and  the 


20  HABITS  THAT  HANDICAP 

money  thus  spent  by  our  Government  would  be 
more  than  sufficient  to  handle  and  distribute  all 
of  the  drug  that  is  needed  for  legitimate  pur- 
poses. Any  druggist  could  of  course  continue 
to  buy  all  that  he  wished,  but  he  would  have  to 
account  for  what  he  bought.  The  drug  would 
serve  only  its  legitimate  purpose,  because  the 
druggist  could  sell  it  only  on  prescription. 
This  would  at  once  eliminate  the  gravest  feature 
of  the  case,  the  indiscriminate  sale  of  proprie- 
tary and  patent  medicines  containing  small 
quantities  of  opium.  The  physician  would  thus 
have  to  shoulder  the  entire  responsibility  for 
the  use  of  any  habit-forming  drug.  With  the 
Government  as  the  first  distributor  and  the 
physician  as  the  last,  the  whole  condition  of 
affairs  would  assume  a  brighter  aspect,  for  it 
would  be  a  simple  matter  to  get  from  the  physi- 
cian a  proper  accounting  for  what  he  had  dis- 
pensed. Thus  the  new  crop  of  users  would  be 
small,  and  less  than  ten  per  cent,  of  the  opium  at 
present  brought  into  this  country  would  be  suf- 
ficient to  meet  every  legitimate  need. 

THE   HABIT-rORMING  I>RUGS 

The    important    habit-forming    drugs     are 
opium,  cocaine,  and  the  small,  but  dangerous, 


THE  PEEIL  OF  THE  DEUa  HABIT    21 

group  of  hypnotics.  These  last — ^trional,  ve- 
ronal, sulphonal,  medinal,  etc. — are  chiefly  coal- 
tar  products,  and  are  not  always  classified  as 
habit-forming  drugs,  but  they  are  such,  and 
there  are  many  reasons  why  the  sale  of  them 
should  be  scrupulously  regulated.  The  opium 
derivatives  go  under  the  general  head  of  nar- 
cotics. Morphine  is  the  chief  active  principle, 
and  codeine  and  heroin  are  the  chief  deriva- 
tives of  morphine.  Codeine  is  one  eighth  the 
strength  of  morphine;  heroin  is  three  times  as 
strong  as  morphine. 

Though  the  general  impression  is  otherwise, 
the  users  of  heroin  acquire  the  habit  as  quickly 
and  as  easily  as  if  they  took  morphine.  Many 
cough  and  asthma  preparations  contain  heroin, 
simply  for  temporary  alleviation,  since,  like 
opium,  it  has  no  curative  power  whatever. 
From  time  to  time  I  have  had  to  treat  cases  of 
heroin-taking  in  which  the  victims  had  thought 
to  satisfy  their  need  for  an  opiate  without  form- 
ing a  habit.  In  the  cases  where  it  was  given  by 
prescription,  it  was  so  given  by  the  physician  in 
the  sincere  belief  that  it  would  not  create  a 
habit.  All  this  despite  the  fact  that  heroin  is 
three  times  stronger  than  morphine,  and  despite 
the  fact  that  physicians  know  that  anything 


22  HABITS  THAT  HANDICAP 

wMch  will  do  the  work  of  an  opiate  is  an  opiate. 
Codeine,  notwithstanding  the  fact  that  it  is 
weaker  than  morphine,  is  likewise  habit-form- 
ing; yet  doctors  prescribe  it  on  account  of  its 
relative  mildness,  even  though  they  know  that 
it  is  the  cumulative  effect  of  continued  doses, 
and  not  the  quantity  of  morphine  in  the  dose, 
which  results  in  habit.  As  with  morphine,  to 
use  either  of  these  drugs  effectively  means  in 
the  long  run  the  necessary  increase  of  the  dose 
up  to  the  limit  of  physical  tolerance. 

The  most  harmful  of  all  habit-forming  drugs 
is  cocaine.  Nothing  so  quickly  undermines  its 
victim  or  provides  so  short  a  cut  to  the  insane 
asylum.  It  differs  from  opium  in  two  im- 
portant ways.  A  man  does  not  acquire  a  habit 
from  cocaine  in  the  sense  that  it  is  virtually  im- 
possible for  him  to  leave  it  off  without  medical 
treatment.  He  can  do  so,  although  he  rarely 
does.  On  withdrawal,  he  experiences  only  an 
intense  and  horrible  depression,  together  with  a 
physical  languor  which  results  in  a  sleepiness 
that  cannot  be  shaken  off.  Opium  withdrawal, 
on  the  other  hand,  results  in  sleeplessness  and 
extreme  nervous  and  physical  disorder.  In  ac- 
tion, too,  cocaine  is  exactly  the  opposite  of 
opium,  for  cocaine  is  an  extreme  stimulant. 


THE  PERIL  OF  THE  DEUG  HAEIT    23 

Its  stimulus  wears  ofP  quickly  and  leaves  a  cor- 
responding depression,  but  it  confers  half  an 
hour  of  capability  of  intense  effort.  That  is 
why  bicycle-riders,  prize-fighters,  and  race- 
horses are  often  doctored,  or  *' doped,"  with 
cocaine.  When  cocaine  gives  out,  its  victim  in- 
variably resorts  to  alcohol  for  stimulus;  alco- 
holics, however,  when  deprived  of  alcohol,  gen- 
erally drift  into  the  use  of  morphine. 

The  widespread  use  of  cocaine  in  the  com- 
paratively short  period  of  time  since  its  dis- 
covery has  been  brought  about  among  laymen 
entirely  by  patent-medicine  preparations  con- 
taining small  quantities  of  it.  These  have  been 
chiefly  the  so-called  catarrh  cures,  which  of 
course  cure  nothing.  With  only  a  two  or  four 
per  cent,  solution,  they  have  created  a  craving, 
and  in  the  end  those  who  could  do  so  have  pro- 
cured either  stronger  solutions  or  the  plain 
crystal.  As  with  the  other  drugs,  in  order  to 
maintain  the  desired  result  the  dose  must  be  in- 
creased in  proportion  as  tolerance  increases. 
Wherever  the  sale  of  patent  medicines  has  been 
restricted  to  those  presenting  a  physician's  pre- 
scription, the  consumption  of  cocaine  has  at  once 
been  lessened.  A  man  cannot  afford  to  get  a 
physician's  prescription  for  a  patent  medicine  j 


24  HABITS  THAT  HANDICAP 

and  even  if  lie  could,  the  reputable  physician  re- 
fuses to  prescribe  one  that  contains  cocaine. 
When  an  overseer  in  the  South  will  deliberately 
put  cocaine  into  the  rations  of  his  negro  labor- 
ers in  order  to  get  more  work  out  of  them  to 
meet  a  sudden  emergency,  it  is  time  to  have 
some  policy  of  accounting  for  the  sale  of  a  drug 
like  cocaine. 

It  is  also  extremely  important  to  regulate  the 
sale  of  the  hypnotic  coal-tar  derivatives.  All 
the  group  of  hypnotics  should  be  buyable  only 
on  a  physician's  prescription.  They  all  disturb 
heart  action  and  impoverish  the  blood,  thereby 
producing  neurotics.  No  physician,  without 
making  a  careful  examination,  will  assume  the 
responsibility  of  prescribing  for  a  man  who 
comes  to  him  in  pain,  yet  a  druggist  does  so  con- 
stantly. He  knows  nothing  of  the  customer's 
idiosyncrasy;  that,  for  instance,  an  amount  of 
veronal  which  would  not  ordinarily  affect  a  child 
may  create  an  intense  nervous  disorder  in  a  par- 
ticular type  of  adult.  To  the  average  druggist 
a  headache  is  only  a  headache ;  he  does  not  know 
that  what  will  alleviate  one  kind  of  headache  is 
exceedingly  bad  for  another  kind,  and  further- 
more it  is  not  his  business  to  warn  the  customer 
that  a  particular  means  of  headache  alleviation 


THE  PERIL  OF  THE  DRUG  HABIT    25 

may  perhaps  make  him  a  nervous  wreck.  The 
patient  usually  has  the  same  ignorance.  In  a 
case  which  was  once  brought  to  my  attention,  a 
girl  swallowed  nine  headache  powders  within 
one  hour.  Had  there  been  ten  minutes'  delay 
in  summoning  a  doctor,  she  would  have  died ;  as 
it  was,  she  was  seriously  ill  for  a  long  time. 

These,  then,  the  narcotics,  cocaine,  and  the 
hypnotics,  are  the  chief  habit-forming  drugs. 
They  form  habits  because  it  is  necessary  to  in- 
crease the  dose  in  order  to  continue  to  derive 
the  apparent  benefit  obtained  from  them  in  the 
beginning,  and  because,  when  once  the  habit  is 
set  up,  it  cannot  be  terminated  without  such 
acute  discomfort  that  virtually  no  one  is  ever 
cured  without  medical  help.  In  drug  addictions 
the  condition  of  the  patient  is  not  mental,  as 
is  generally  supposed,  but  physical.  Definite 
medical  treatment  to  remove  the  effects  of  the 
drug  itself  is  imperative,  whether  the  victim  be 
suffering  from  the  drug  habit  alone  or  from  that 
habit  in  a  body  otherwise  physically  disordered. 
With  regard  to  the  cure  of  the  habit,  as  in  the 
case  of  the  conditions  which  permit  of  its  being 
acquired,  it  may  justly  be  said  that  the  victims 
have  been  unfairly  treated. 


26  HABITS  THAT  HANDICAP 

THE  NEEiD   OF   CONTROL  BY  THE  GOVERNMENT  AND 
BY   PHYSICIANS 

The  prevalence  of  the  drug  habit,  the  magni- 
tude of  which  is  now  startling  the  whole  civilized 
and  uncivilized  world,  can  be  checked  only  in  one 
way — ^by  controlling  the  distribution  of  habit- 
forming  drugs.  "With  the  Government  as  the 
first  distributor  and  a  physician  as  the  last, 
drug-taking  merely  as  a  habit  would  cease  to  be. 
If  physicians  were  made  accountable,  they  would 
use  narcotics,  hypnotics,  and  cocaine  only  when 
absolutely  necessary.  Nobody  should  be  per- 
mitted to  procure  these  drugs  or  the  means  of 
using  them  or  any  medicines  containing  them 
without  a  doctor's  prescription.  By  such  re- 
striction the  intense  misery  due  to  the  drug 
habit  would  be  decreased  by  nine  tenths,  indeed, 
by  much  more  than  this ;  for  when  a  physician 
dares  no  longer  to  be  content  with  the  mere  alle- 
viation of  pain,  which  is  only  nature's  way  of 
announcing  the  presence  of  some  diseased  con- 
dition, he  will  seek  the  more  zealously  to  dis- 
cover and  remove  its  cause. 


CHAPTER  II 

THE  NEED  OP  ADEQUATE  SPECIFIC   TREATMENT  FOR 
THE  DRUG-TAKER 

THE  Internal  Revenue  Reports  are  the  only 
index  to  the  extent  of  the  drug  consump- 
tion in  the  United  States.  They  show  for  years 
past  an  annual  increase  in  the  importation  of 
opium  and  its  derivatives  and  cocaine,  and  for 
last  year  a  very  marked  increase  over  that  of 
any  preceding  year.  This  is  not  due  to  the  in- 
crease in  population;  our  immigrants  are  not 
drug-takers.  Among  the  thousands  of  drug- 
users  that  I  have  treated  or  known,  I  have  never 
seen  an  Italian,  a  Hungarian,  a  Russian,  or  a 
Pole.  Moreover,  I  have  met  with  only  four 
cases  of  drug-taking  by  Hebrews.  Few  Jews — 
except  in  the  under-world — acquire  the  habit 
knowingly.  It  may  become  fastened  upon  them 
through  the  use  of  a  medicine  the  danger  of 
which  they  do  not  realize,  but,  once  freed,  they 
will  not  again  come  under  its  power.  The  prac- 
tical sagacity  of  their  race  is  their  surest  safe- 
guard. 


28  HABITS  THAT  HANDICAP 

What  is  commonly  spoken  of  as  tlie  "Ameri- 
can type,"  Mglaly  nervous,  living  under  pres- 
sure, always  going  to  the  full  limit,  or  beyond, 
is  peculiarly  liable  to  disorders  that  lead  to  the 
habitual  use  of  drugs.  We  are  all  hypochon- 
driacal by  nature,  prone  to  ''take  something" 
whenever  we  feel  badly.  Lack  of  opportunity 
alone,  of  knowledge  of  what  to  take  and  how  to 
procure  it,  has  saved  many  a  person  under  se- 
vere physical  or  mental  strain  from  recklessly 
resorting  to  drugs.  Since  the  passage  of  the 
Pure  Food  and  Drugs  Act,  which  was  intended 
to  protect  the  public  by  requiring  the  express 
statement  of  any  dangerous  ingredients  in  a 
compound,  the  sale  of  preparations  containing 
habit-forming  drugs  has  preceptibly  increased. 
It  seems  a  just  inference  that  the  information 
given,  instead  of  serving  as  a  warning  to  the 
unwary,  has  been  chiefly  effective  in  pointing 
out  a  dangerous  path  to  many  who  otherwise 
would  not  have  known  where  to  find  it. 

Women,  it  should  be  said,  though  constitu- 
tionally more  liable  than  men  to  feel  the  need 
of  medicines,  form  the  lesser  portion  of  the 
drug-taking  class.  In  the  beginning  their  ad- 
diction is  due  almost  exclusively  to  a  physician's 
prescription,  except  in  the  under-world^ 


TEEATMENT  FOR  DRUG-TAKER    29 

The  habitual  users  of  drugs  in  the  United 
States  come  from  every  grade  of  society.  Pro- 
fessional men  of  the  highest  responsibility  and 
repute,  laborers  wearying  of  the  dullness  in  a 
mining-camp,  literary  men,  clergymen,  newspa- 
per men,  wire-tappers,  shoplifters,  vagrants, 
and  outcasts — all  are  among  the  number. 
Strangely  assorted  as  they  are,  they  become  yet 
more  strangely  alike  under  the  influence  of  the 
common  habit.  Shoplifting  is  not  confined  to 
the  professional  thief ;  it  is  noticeable  in  many  a 
drug-user  who  has  had  every  moral  and  worldly 
advantage. 

The  major  part  of  the  habit-forming  drugs 
used  in  the  United  States  is  consumed  by  the 
under-world.  It  would  be  impossible  to  calcu- 
late the  extent  of  their  influence.  Many  a 
record  of  heinous  crime  tells  of  the  stimulus  of 
a  drug.  But  when  the  school-children  in  some 
of  our  larger  cities  are  found  to  be  using  co- 
caine, and  able  to  buy  it  at  will,  the  limit  of  tol- 
erance has  surely  been  reached. 

THE  DRUG-TAKING  PHYSICIAN,   NURSE,  AND 
PHARMACIST 

Among  the  widely  varying  classes  of  drug- 
users,  three  in  particular  are  a  source  of  the 


30  HABITS  THAT  HANDICAP 

gravest  danger:  the  drug-taking  physician, 
nurse,  and  pharmacist.  To  realize  this,  one  has 
merely  to  recall  that  the  drug-taker  is  a  con- 
firmed evader  of  responsibility;  and  the  physi- 
cian, of  all  men,  is  in  a  responsible  position. 
He  must  not  forget  or  break  his  appointments ; 
he  must  realize  the  effects  of  the  medicines  he  is 
prescribing;  if  a  surgeon,  his  work  must  never 
be  below  its  best.  But  the  proportion  of  physi- 
cians that  I  have  treated,  or  consulted  with, 
suggests  one  specially  grave  danger.  It  is  a 
characteristic  of  the  drug-taker,  no  matter  who 
he  is  or  how  he  acquired  the  habit,  on  the  small- 
est excuse  to  advise  others  to  take  the  drug 
whenever  pain  or  fatigue  gives  the  slightest  oc- 
casion for  it.  While  he  grows  callous  to  every- 
thing else,  he  has  an  abnormal  sympathy  with 
suffering.  Thus  it  will  readily  be  seen  that 
there  are  few  more  dangerous  members  of  so- 
ciety than  the  physician  who  is  addicted  to  a 
drug. 

The  fact  that  there  are  not  more  drug-taking 
doctors  speaks  volumes  for  the  high  character 
of  the  profession.  The  physician  has  such 
drugs  constantly  at  hand.  The  more  a  man 
knows  of  their  insidious  action  and  the  more  he 
handles  them,  the  more  cautious  he  feels  him- 


TREATMENT  FOR  DRUG-TAKER    31 

self  to  be,  and  tlie  more  confident  that  he  can 
discontinue  the  use  of  them  whenever  he  chooses. 
Any  fear  that  the  layman  may  have  of  them  is 
due  less  to  the  dread  of  being  personally  over- 
come than  to  the  mystery  which  surrounds 
them;  but  for  the  physician  they  have  no  such 
mystery.  Furthermore,  by  the  nature  of  his 
calling  he  is  peculiarly  exposed  to  the  need  of 
such  drugs.  He  is  often  under  excessive  phys- 
ical and  nervous  strain  not  only  because  he  is 
unable  to  arrange  his  work  so  as  to  prevent 
periods  of  too  great  pressure  upon  his  time  and 
strength,  but  also  because  in  a  unique  manner  he 
puts  his  heart  into  it. 

An  even  greater  danger,  in  some  respects,  is 
the  drug-taking  professional  nurse.  Whatever 
has  been  said  of  physicians  both  in  the  way  of 
extenuation  and  of  warning  may  be  repeated  of 
nurses.  They  have  the  same  exposure  to  the 
habit,  and,  once  addicted,  are  likely  to  exhibit 
signs  of  irresponsibility.  They  are  more  dan- 
gerous in  that  their  opportunity  for  mischief  is 
greater,  since  they  are  closer  to  the  patient  and 
able  to  thwart  the  doctor's  orders  with  perfect 
freedom.  ''I  have  had  several  nurses  on  this 
drug  case,'^  a  doctor  once  said  to  me,  **and  I 
find  that  they  have  all  smuggled  morphine  to 


32  HABITS  THAT  HANDICAP 

my  patient."  This  was,  no  doubt,  an  excep- 
tional case,  but  the  fact  remains  that  nurses,  be- 
cause of  their  close  alliance  with  druggists  and 
doctors,  find  it  comparatively  easy  to  purchase 
drugs  and  hypodermics  at  any  drug  store  with- 
out causing  the  slightest  suspicion  or  reproof. 
Nor  should  one  censure  them  too  severely  for 
clandestine  compliance  with  the  demands  of  a 
patient.  It  should  not  be  overlooked  that  the 
nurse,  in  being  paid  by  the  patient  and  not  by 
the  doctor,  is  ordinarily  subjected  to  great 
pressure  when  the  patient  clamors  for  mor- 
phine. In  such  circumstances  the  protection  of 
a  physician's  monopoly  of  the  drug  would  be 
most  welcome.  But  how  much  worse  is  the 
pressure  when  the  well-intentioned  nurse  also 
is  a  drug-taker !  The  morphinist  has  an  abnor- 
mal sympathy  with  those  who  have  undergone 
or  are  undergoing  experiences  similar  to  his 
own,  and  there  is  no  stronger  bond  than  that 
which  unites  two  morphine  victims.  As  a  mat- 
ter of  the  most  elementary  precaution  for  all 
concerned,  no  nurse  should  under  any  condi- 
tions be  allowed  to  buy  habit-forming  drugs. 

Another  kind  of  drug-taker  against  whom 
physicians'  distribution  would  be  a  safeguard, 
and  the  only  safeguard  that  can  be  devised,  is 


TREATMENT  FOR  DRUa-TAKER    33 

the  pharmacist.  The  contingency  of  a  drug- 
taking  pharmacist,  perhaps  more  than  anything 
else,  will  bring  sharply  home  to  the  average 
man  the  menace  of  morphine  when  used  by  a 
professional  person.  By  reason  of  closer  and 
more  personal  observation  one  may  feel  rashly 
confident  of  his  ability  to  detect  when  a  doctor 
or  a  nurse  is  "queer,"  but  generally  the  patron 
of  a  drug  store  has  no  such  opportunity  for  ob- 
servation. Addiction  to  a  drug  incapacitates 
the  pharmacist  for  filling  prescriptions.  Often 
the  slightest  deviation  from  a  precise  formula 
in  either  quantity  or  ingredient  is  of  the  grav- 
est consequence,  and  hence  the  utmost  care 
should  be  used  to  insure  the  scrupulousness  of 
one  on  whom  such  responsibility  rests.  As 
long  as  he  is  accountable  to  no  one,  or  even  ac- 
countable to  the  Government  only  on  a  business 
basis,  there  can  be  no  safety  for  the  public.  If 
he  may  sell  to  any  purchaser  other  than  a  physi- 
cian, he  may  always  supply  his  own  wants.  But 
if  he  has  to  account  to  a  physician  for  the  en- 
tire amount  of  habit-forming  drugs  that  he  dis- 
tributes, any  leakage  may  quickly  be  detected 
by  the  man  who  more  than  any  one  else  can  be 
relied  upon  to  stop  such  a  leakage  promptly  and 
sternly.    A  pharmacist  should  be  allowed  to 


34  HABITS  THAT  HANDICAP 

dispense  habit-forming  drugs  only  on  a  physi- 
cian's prescription. 

The  physician  should  be  limited  as  to  his  au- 
thority not  only  for  prescribing  such  drugs, 
but,  as  the  Boylan  Act  provided,  there  must  be 
a  careful  accounting  on  his  part  for  all  such 
drugs  administered  or  given  away.  In  other 
words,  he  must  account  for  all  such  drugs  which 
he  buys  for  office  use,  and  he  cannot  prescribe 
such  drugs  except  under  certain  definite  limita- 
tions. 

METHODS    OF    TREATMENT:      '^THE    HOME    CUEE^' 

For  many  years  only  two  methods  of  dealing 
with  the  drug  habit  were  known.  They  con- 
tinue to  be  the  only  ones  in  general  use  to-day. 
They  are  the  **home  cure"  and  the  sanatorium 
method.  Neither  is  in  any  proper  sense  a 
treatment  or  anything  more  than  a  process  of 
substitution  and  deprivation. 

In  many  of  the  periodicals  and  daily  papers 
are  carefully  worded  advertisements  setting 
forth  that  a  man  may  be  cured  of  a  drug  habit 
quickly,  secretly,  painlessly,  and  inexpensively. 
These  are  written  by  people  who  thoroughly  un- 
derstand the  mental  and  physical  condition  of 
the  drug-taker.    In  almost  all  cases  he  wishes 


TREATMENT  FOR  DRUG-TAKER    35 

to  be  freed  from  the  habit,  but  at  the  same  time 
to  avoid  the  disgrace  of  being  classed  with 
"drug-fiends";  he  is  unwilling  that  even  his 
family  or  his  intimates  should  know  of  his  con- 
dition. He  has  an  exaggerated  sensitiveness  to 
pain,  upon  which  also  the  advertisement  relies. 
Furthermore,  attention  is  directed  to  the  fact 
that  the  patient  may  take  the  alleged  remedy 
without  spending  much  more  money  than  he  has 
been  spending  for  the  drug  itself,  naturally  a 
powerful  appeal  to  a  man  of  limited  means. 
Moreover,  the  people  who  take  these  "cures" 
are  generally  those  who  are  unable  to  consider 
the  expense  of  leaving  home.  That  the  adver- 
tisement is  very  alluring  to  the  average  drug- 
taker  is  shown  by  the  fact  that  in  my  entire 
practice  I  have  encountered  few  patients  who 
have  not  at  some  time  or  other  taken  a  home 
iGure. 

i|"  A  minister  wrote  to  me  the  other  day  beg- 
!cging  me  to  cure  a  fellow-minister  of  the  cure 
;  habit.  His  friend  had  had  occasional  attacks 
of  renal  colic,  and  a  physician  had  eased  their 
acuteness  with  a  hypodermic.  The  patient  of 
course  knew  what  he  was  taking,  and  since  he 
was  forced  to  consider  the  cost  of  the  physi- 
cian's visits  for  the  mere  administration  of  the 


36  HABITS  THAT  HANDICAP 

hypodermic,  lie  naturally  procured  Ms  own  out- 
fit, and  in  a  short  time  was  using  it  regularly 
upon  himself.  When  he  found  that  he  could  not 
leave  off  the  practice  he  entered  into  correspond- 
ence with  a  succession  of  "home-cure"  adver- 
tisers, whose  clever  use  of  the  word  "privacy" 
offered  a  hope  that  his  condition  might  be  con- 
cealed from  his  congregation.  For  ten  years  he 
had  been  undergoing  the  cures,  and  during  all 
this  time  had  been  forced  to  take  a  regular 
dosage  of  the  so-called  remedies. 

Before  the  passage  of  the  Pure  Food  and 
Drugs  Act  the  ingredients  of  such  remedies 
were  not  stated.  The  patient  seems  never  to 
have  suspected  the  truth — that  the  bottle  con- 
tained the  very  drug  he  had  been  taking,  its 
presence  disguised  by  added  medicines.  In  cer- 
tain instances  the  makers  boldly  advertised  that 
a  trial  bottle  would  be  sufficient  to  prove  clearly 
that  the  taker  could  not  get  along  without  using 
his  drug.  Now  that  the  law  compels  a  list  of 
dangerous  drugs  on  the  label,  the  cures  proceed 
admittedly  by  a  reductive  principle.  The  pa- 
tient graduates  from  a  number  one  bottle  to  a 
number  two,  containing  less  opium,  and  so  on, 
until  finally  he  is  supposed  to  be  cured.  The 
proprietors  of  these  cures  make  a  great  deal  of 


TEEATMENT  FOE  DEUG-TAKEE     37 

capital  out  of  the  fact  that  the  reduction  is  so 
gradual  that  the  taker  experiences  no  discom- 
fort. This  consideration  is  highly  effective, 
for  while  it  irresistibly  appeals  to  the  mor- 
bidly sensitive  morphinist,  it  also  makes  him 
comprehend,  as  time  goes  on,  why  the  proc- 
ess of  cure  is  so  slow.  It  is  hardly  necessary 
to  state  that  the  final  stage  is  almost  never 
reached. 

Almost  without  exception,  the  basis  of  restor- 
ation to  health  is  the  perfect  elimination  of  the 
effects  of  the  drug.  It  should  go  without  say- 
ing that  it  is  impossible  to  eliminate  the  effects 
of  opium  with  opium  or  to  find  any  substitute 
for  opium  that  is  not  itself  opium.  At  the  In- 
ternational Opium  Conference  in  China  I  ex- 
hibited seventy-six  opium-cures  which  I  had  had 
analyzed  and  found  to  contain  opium ;  and  as  a 
consequence  of  the  Pure  Food  and  Drugs  Act 
all  the  American  *' cures"  announced  on  their 
labels  that  they  also  contained  it.  Thus  it  is 
easy  to  see  why  the  sale  of  these  cures  had  al- 
ways greatly  increased  wherever  the  rigid  en- 
forcement of  anti-opium  enactments  had  closed 
up  the  customary  sources  of  habit-forming 
drugs. 

Up  to  the  passage  of  the  act,  however,  the 


38  HABITS  THAT  HANDICAP 

presence  of  opium  in  the  American  cures  was 
concealed,  and  their  formulas  were  kept  secret ; 
and  hence  all  of  them,  by  the  very  nature  of  the 
case,  were  put  forth  either  by  irresponsible  per- 
sons or  by  persons  outside  the  pale  of  the  pro- 
fession ;  for  one  of  the  pledges  given  by  a  physi- 
cian is  that  he  will  not  patronize  or  employ  any 
secret  treatment,  and  that  he  will  give  to  the 
profession  whatever  he  finds  to  be  of  benefit  to 
his  fellow-men. 

In  very  rare  cases  these  home  cures  have  been 
able  to  relieve  a  man  of  strong  will  power,  with 
the  added  assistance  of  a  regimen  for  building 
up  his  bodily  tone.  But  these  cases  have  been 
so  infrequent  as  to  be  virtually  negligible,  for 
to  administer  the  treatment  successfully  de- 
mands from  the  patient  the  exercise  of  precisely 
that  power  of  self-control  the  loss  of  which 
drove  him  to  the  cure  in  the  first  place.  If 
there  ever  was  any  curative  property  in  one 
of  these  so-called  cures,  a  man  could  not  be 
benefited  unless  he  were  under  constant  super- 
vision. A  treatment  of  this  sort  must,  except 
in  case  of  a  miracle,  be  administered  by  another 
and  under  continuous  medical  surveillance.  A 
man  addicted  to  a  drug,  be  he  physician  or 
longshoreman,  in  a  short  time  becomes  utterly 


TREATMENT  FOR  DRUG-TAKER     39 

unable  to  deal  justly  with  liimself,  for  it  is  the 
nature  of  the  drug  to  destroy  his  sense  of  re- 
sponsibility. 

THE   SANATOEIUM   TREATMENT 

Besides  the  home  cure  there  was,  and  is,  the 
sanatorium  treatment.  Unlike  the  former,  this 
was  first  established  and  carried  on  by  trust- 
worthy medical  men,  who  depended  for  their 
support  upon  the  patients  of  reputable  doctors. 
A  physician  who  had  a  morphine  patient  was 
obliged  to  send  him  to  a  sanatorium  because 
there  was  nothing  else  to  be  done  with  him; 
elsewhere  no  course  of  treatment  under  con- 
stant surveillance  could  be  given.  It  afforded 
the  only  opportunity  of  carrying  the  patient 
through  the  long  period  of  gradual  reduction 
which  was  then  the  only  known  treatment. 
Thus  there  was  nothing  optional  about  the  mat- 
ter ;  the  physician  could  not  recommend  a  home 
cure,  and  the  only  means  of  approximating  sys- 
tematic treatment  was  the  sanatorium.  Fur- 
thermore, those  relatives  and  friends  who  knew 
of  the  patient's  condition  were  anxious  that  he 
should  go  to  one,  since  they  realized  the  in- 
creasing awkwardness  of  keeping  him  at  home. 
In  many  cases,  indeed,  they  even  went  so  far  as 


40  HABITS  THAT  HANDICAP 

to  resort  to  means  of  commitment,  if  they  failed 
to  get  his  voluntary  cooperation.  It  is  due  to 
the  ease  with  which  this  type  of  patient  can  be 
committed  that  the  State  of  Connecticut,  for  in- 
stance, abounds  in  sanatoriums.  In  that  State, 
when  a  patient  has  entered  one  of  them,  he  can 
often  be  detained  there  virtually  at  the  pleasure 
of  his  relatives  and  friends. 

The  method  of  treatment  at  most  of  the  sana- 
toriums is  like  the  home  cure,  except  that  it  is 
under  surveillance ;  that  is,  it  is  merely  one  of 
gradual  reduction  accompanied  by  an  upbuild- 
ing of  bodily  tone.  The  morphine-taker  with 
means  and  time  at  his  disposal  will  stay  in  a 
sanatorium  as  long  as  he  can  be  made  comfort- 
able. This  shows  that  whatever  reduction  he 
has  undergone  is  extremely  slight;  for  gradual 
reduction,  when  it  is  carried  to  any  extent,  sets 
up  a  highly  nervous  state,  together  with  in- 
somnia and  physical  disturbance.  The  pa- 
tient, as  is  often  said,  has  an  exaggerated  dread 
of  discomfort,  and  will  not,  if  he  can  help  it, 
endure  it  at  all.  Unless  he  is  committed,  he 
transfers  himself  to  another  sanatorium  the 
moment  he  ceases  to  be  made  comfortable.  I 
had  one  patient  whose  life  had  been  a  continu- 
ous round  of  sanatoriums.    He  would  stay  in 


TEEATMENT  FOE  DEUG-TAKEE    41 

one  place  until  the  point  was  reached  where  dis- 
comfort was  in  sight,  and  then  remove  to  an- 
other, remaining  there  for  a  similar  period,  and 
then  to  another,  and  so  on,  until  he  had  finished 
a  long  round  of  sanatoriums  to  his  taste  in 
America  and  Europe.  Then  he  would  begin  all 
over  again. 

A  patient  of  mine  who  had  visited  eight  dif- 
ferent sanatoriums  in  the  vicinity  of  New  York 
told  me  that  in  America  the  sanatorium  treat- 
ment of  neurological  patients  was  divided  into 
three  great  schools:  the  * 'forge  t-it"  system,  the 
*'don't-worry"  system,  and  the  ** brace-up'* 
system.  Any  nervous  invalid  who  has  stayed 
much  at  sanatoriums  will  appreciate  the  humor 
of  this  classification. 

The  gravest  aspect  of  these  long  stays  at  a 
sanatorium  is  the  unavoidable  colonization. 
Picture  to  yourself  a  group  of  from  half  a 
dozen  to  fifty  morphine  patients,  eating  to- 
gether, walking  together,  sitting  on  the  ver- 
anda together,  day  in  and  day  out.  In  this 
group  are  represented  many  different  tempera- 
ments and  many  different  stations  of  life,  from 
the  gambler  to  the  clergyman.  All  the  more 
on  this  account  is  there  a  general  and  eager  dis- 
pussion  of  previous  history  and  present  situa- 


42  HABITS  THAT  HANDICAP 

tion.  For  where  the  alcoholic  is  quite  indiffer- 
ent, the  morphine  victim  has  an  insatiable  in- 
terest in  symptoms.  He  has  also  an  excessive 
sympathy  with  all  who  have  been  through  the 
same  mill  with  himself.  Thus,  in  a  matter 
where  individual  and  isolated  treatment  is  im- 
perative, most  sanatoriums  deal  with  patients 
collectively.  Furthermore,  these  are  peculiarly 
a  class  of  unfortunates  who  ought  never  to  be- 
come acquainted.  Whatever  moral  restraint 
the  habit  has  left  in  a  man  is  completely  relaxed 
when  he  hears  constant  bragging  of  trickery 
and  evasion  and  has  learned  to  envy  the  clev- 
erness and  resource  so  exhibited.  The  self- 
respect  and  pride  which  must  be  the  main  fac- 
tors in  his  restoration  are  sometimes  fatally 
weakened.  Colonization  should  be  restricted 
to  the  hopeless  cases,  and  to  them  only  because 
it  is  unhappily  necessary. 

FAILURE   OF   THE   REDUCTION   METHOD 

All  this,  moreover,  is  never,  or  almost  never, 
to  any  purpose.  As  the  uncomfortable  patient 
will  move  if  possible,  it  is  naturally  the  business 
of  the  sanatorium  to  keep  him  from  being  un- 
comfortable. The  method  of  reduction,  there- 
fore, is  rarely  carried  out  to  the  point  where  it 


TREATMENT  FOR  DRUG-TAKER    43 

would  do  any  good,  even  if  good  were  thus  pos- 
sible. But  it  is  not  possible.  In  the  first  place, 
lessening  the  dose  is  of  little  avail ;  there  is  as 
much  suffering  in  the  final  deprivation  of  a  cus- 
tomary quarter  of  a  grain  as  of  twenty  grains. 
In  the  second  place,  it  cannot  be  ascertained  by 
gradual  reduction  whether  there  is  any  disa- 
bility which  makes  morphine  necessary,  since 
no  intelligent  diagnosis  can  be  made  so  long  as 
a  patient  is  under  the  influence  of  the  smallest 
quantity  of  the  drug.  Obviously,  the  first  step 
in  taking  up  a  case  should  be  to  discover 
whether  any  such  disability  is  present,  and,  if 
so,  whether  it  is  one  that  can  be  corrected; 
otherwise  it  may  be  a  waste  of  time  to  try  to 
correct  it.  The  true  physical  condition  of  the 
patient,  which  should  be  considered  before  a 
long  course  of  treatment  is  undertaken,  can  sel- 
dom be  discovered  by  the  reduction  method. 

The  best  doctors  have  always  felt  that  they 
could  not  afford  to  lend  their  names  to  any  in- 
stitutions or  sanatoriums  except  those  which  re- 
stricted themselves  to  mental  cases.  Yet  these 
home  cures  and  sanatoriums,  unscientific  and 
ineffective  as  they  were,  have  offered  to  the  vic- 
tims of  the  drug  habit  the  only  hope  they  could 
find.    The  investigations  begun  by  Mr.  Taft  in 


44  HABITS  THAT  HANDICAP 

the  Philippines  extended  over  considerable  time 
and  cost  two  hundred  and  fifty  thousand  dol- 
lars, but,  although  furthered  in  every  way  by 
the  whole  world,  they  failed  to  discover  a  defi- 
nite treatment  for  the  drug  habit.  It  was  gen- 
erally believed  by  physicians  that  there  was  no 
hope  for  the  victims  of  it. 

COST   OF   THE   DRUG   HABIT 

It  may  be  noted  that  I  have  not  dwelt  upon 
the  expense  of  the  habit.  This  consideration 
may  be  omitted  from  the  case.  To  the  average 
victim,  the  cost  of  his  drugs,  r.o  matter  what 
he  may  have  to  pay  for  them,  seems  moderate. 
He  is  buying  something  which  he  deems  a  vital 
necessity,  and  which,  moreover,  he  places,  if  a 
choice  be  required,  before  food,  drink,  family, 
sleep,  pleasures,  tobacco — every  necessity  or  in- 
dulgence of  the  ordinary  man. 

The  real  cost  is  not  to  the  drug-taker,  but  to 
the  world.  If  a  human  life  be  considered 
merely  as  a  thing  of  economic  value,  an  estimate 
may  perhaps  be  made  of  the  total  loss  due  to 
the  habit. 

But  the  loss  should  not  be  reckoned  in  any 
such  way.  It  should  rather  be  reckoned  by  the 
great  amount  of  moral  usefulness  and  good 


TEEATMENT  FOE  DEUG-TAKEE    45 

tliat  migM  be  rendered  to  tlie  world  if  these  un- 
fortunates could  be  freed  from  their  slavery, 
and  by  the  actual  harm  being  done  by  them, 
especially  by  those  that  are  now  loosely  classed 
as  criminals  and  degenerates. 

The  retrieving  of  much  of  the  waste  of  hu- 
manity may  be  accomplished  by  adequate  treat- 
ment of  the  drug  habit. 


CHAPTER  III 

THE  DRUG-TAKER  AND   THE  PHYSICIAIT 

THE  doctor  who  begins  to  take  tlie  drug  in 
order  to  whip  his  flagging  energies  into 
new  effort  finds  the  habit  fastened  on  him  be- 
fore he  realizes  what  has  occurred.  His  en- 
deavors to  reduce  his  daily  dosage  fail,  and  he 
becomes  thoroughly  enmeshed.  His  acquired 
tolerance  for  the  drug  has  brought  about  so 
great  a  physical  change  that  deprivation  or  even 
reduction  of  dosage  is  intolerable.  Hundreds 
of  cases  where  physicians  had  experimented 
with  the  drug  with  these  disastrous  results 
have  been  brought  to  my  attention. 

No  one  shows  less  foresight,  less  apprecia- 
tion of  the  danger  of  tampering  with  drugs,  than 
the  physician  himself.  I  am  constantly  amazed 
by  the  fact  that  any  doctor  will  take  even  the 
slightest  risk  of  becoming  a  drug-user.  That 
many  voluntarily  incur  the  peril  passes  my  un- 
derstanding. 

I  have  seen  an  astonishing  number  of  physi- 

46 


DRUG-TAKER  AND  PHYSICIAN     4? 

cians  wlio  for  various  physical  reasons  other 
than  exhaustion  and  the  need  of  stimulant  con- 
sidered themselves  eligible  to  experiment  with 
drugs.  It  is  a  curious  thing  that,  as  a  class, 
physicians  and  surgeons  are  themselves  singu- 
larly averse  to  submitting  to  surgical  operation, 
even  when  symptomatic  indications  strongly 
urge  it.  Why  surgeons,  in  particular,  should  so 
generally  dread  the  application  of  the  knife  in 
their  own  cases  is  a  puzzle,  for  of  course  no 
class  more  thoroughly  understands  the  need  of 
surgery.  I  could  mention  many  cases  of.  this 
sort,  but  one  in  particular  recurs  to  my  memory. 
He  was  one  of  the  most  careful  and  best- 
informed  doctors  in  the  country,  and  he  was  not 
without  a  certain  special  knowledge  of  the  peril 
involved  in  habit-forming  drugs;  but  he  suf- 
fered from  a  painful  rectal  trouble,  and  al- 
though he  considered  himself  too  intelligent  a 
man  to  go  too  far  with  a  dangerous  substance, 
he  did  go  too  far.  He  had  thought  that  he  could 
leave  drugs  off  whenever  he  desired;  he  found 
that  he  could  not. 

THE   PHYSICIAN   WHO   TAKES   DRUGS 

It  is  impossible  to  make  even  an  approxi- 
mately  accurate  guess   at  the  proportion  of 


48  HABITS  THAT  HANDICAP 

physicians  who  are  drug-users.  Everywhere 
except  in  New  York  State  physicians  can  obtain 
as  many  drugs  as  they  desire  without  publicity 
and  without  laying  themselves  open  to  any  pen- 
alty whatsoever,  even  if  their  purchases  are 
brought  to  official  attention.  No  medical  or- 
ganization takes  any  cognizance  of  drug-taking 
physicians  or  provides  any  medical  help  for 
them.  It  is  highly  probable  that  the  New  York 
State  legislation  may  uncover  some  of  the  drug- 
taking  doctors  in  that  commonwealth,  though 
this  is  by  no  means  certain,  since  legisla- 
tion in  force  in  only  one  State  cannot  effectively 
put  a  stop  to  the  illegal  importation  of  habit- 
forming  drugs  from  other  States  and  countries. 
Proper  restrictive  legislation  of  sufficiently  wide 
scope  would  very  quickly  disclose  every  drug- 
taking  doctor  in  the  nation,  and  either  force  him 
to  correct  his  physical  condition  or  drive  him 
from  the  profession.  Proper  general  regula- 
tion of  the  traffic  and  consumption  of  habit- 
forming  drugs  will  aid  tremendously  in  freeing 
the  medical  profession  from  drug-takers.  Un- 
til this  general  regulation  exists  no  general  re- 
form will  be  possible.  An  exact  accounting  for 
every  grain  of  habit-forming  drugs  which  he 
purchases,  possesses,  or  administers,  must  be 


DEUG-TAKEE  AND  PHYSICIAN     49 

demanded  of  every  physician  in  the  United 
States  before  this  evil  can  be  entirely  abated; 
and  this  accounting  among  physicians  will  be 
impossible  until  a  similar  accounting  is  de- 
manded of  every  grain  imported,  manufactured, 
and  dispensed  by  wholesale  and  retail  druggists. 

Concerning  the  extent  of  the  hold  which  the 
drug  habit  has  upon  physicians  I  have  had  a 
rare  opportunity  to  judge.  Not  only  has  my 
dealing  with  the  drug  habit  been  as  exclusively 
as  possible  through  the  physician  rather  than 
through  the  patient,  but  the  brevity  of  my  treat- 
ment and  the  privacy  that  my  patients  are  as- 
sured make  it  possible  for  many  physicians  who 
have  become  afflicted  to  come  to  me  for  relief 
without  arousing  in  the  mind  of  any  one  a  sus- 
picion of  the  real  cause  for  their  brief  absence. 
I  therefore  feel  that  I  have  a  firm  basis  for  accu- 
racy. 

It  is  the  fear  of  disgrace  which  has  driven 
hundreds  of  physicians  from  bad  to  worse  with 
the  drug  habit :  they  have  become  apprehensive 
that  any  effort  tending  to  their  relief  will  un- 
cover their  position  to  their  families,  associates, 
or  patients,  and  thus  bring  ruin;  so  they  have 
drifted  on  from  bad  to  worse.  Many  who  have 
not  taken  steps  in  time  have  reached  the  irre- 


50  HABITS  THAT  HANDICAP 

sponsible  and  hopeless  stage.  To  the  medical 
profession  in  general,  as  well  as  to  the  public, 
these  men  are  a  dreadful  menace. 

ATTITUDE   OF   THE  PEOEESSION 

I,  a  layman,  have  been  greatly  surprised  that 
the  medical  world  shows  so  little  sympathy  for 
these  unfortunates.  This  seems  to  me  to  be 
specially  reprehensible,  since  by  this  neglect 
they  imperil  the  public.  No  greater  service 
could  be  rendered  to  mankind  by  the  medical 
profession  than  a  concerted  movement  of  the 
medical  organizations  toward  the  care  and  re- 
lief of  those  among  their  drug-taking  members 
who  are  still  susceptible  to  help,  and  the  ex- 
clusion from  medical  practice  of  those  who 
have  already  gone  too  far  to  be  reclaimed. 
Physicians  of  this  class  who  are  without  means 
are  specially  entitled  to  sympathy  and  help,  and 
this  service  will  be  of  double  value,  for  it  will  not 
only  give  them  necessary  aid,  but  will  notably 
safeguard  the  public.  No  physician  should  be 
permitted  to  practise  who  is  addicted  to  the  use 
of  habit-forming  drugs  or  who  uses  alcoholic 
stimulants  to  excess ;  but  whatever  is  done  in  re- 
gard to  these  men  should  be  accomplished  with- 
out publicity  and  without  any  loss  of  pride  or 


DRUG-TAKEE  AND  PHYSICIAN     51 

standing.  A  doctor  who  has  used  either  drugs 
or  alcohol  is  much  more  to  be  pitied  than 
blamed. 

The  worthy  practitioners — and  there  are 
many — ^who  must  resort  to  the  use  of  drugs  in 
order  to  enable  them  to  practise  despite  some 
physical  disability  which  cannot  be  eliminated, 
are  no  less  numerous  in  proportion  to  the  total 
number  of  physicians  than  similar  cases  are  in 
relation  to  the  total  number  of  lawyers,  mer- 
chants, or  journalists,  but  because  of  the  nature 
of  their  work,  they  are  far  more  dangerous  to 
the  general  public.  It  seems  to  me  that  there 
is  in  this  fact — the  existent,  non-elimination  of 
such  perilous  characters  from  the  practice  of 
medicine,  and  the  obvious,  very  real  necessity 
for  such  an  elimination — a  suggestion  for  some 
person  of  philanthropic  mind.  If  the  medical 
profession  will  not  care  for  its  own,  then  some 
one  else  must  care  for  them.  It  occurs  to  me 
that  among  the  people  whose  naturally  fine  im- 
pulses are  leading  them  toward  the  endowment 
of  institutions  for  the  care  of  the  aged  maiden 
lady,  or  superannuated  teachers,  or  others  to 
whom  fate  has  been  unkind,  there  are  many  who 
might  well  consider  this  great  need  for  the  es- 
tablishment of  a  comfortable  institution  in  this 


52  HABITS  THAT  HANDICAP 

country  for  tlie  care  of  physicians  who  through 
no  fault  of  their  own  have  become  unable  to 
practise  their  profession  with  profit  and  effi- 
ciency. 

HOW   THE  DOCTOR  BECOMES  A  DEUG-TAKEE 

The  doctor's  yielding  to  the  drug  habit  is  a 
simple  process,  in  ninety-nine  cases  out  of  a 
hundred  unaccompanied  by  any  unworthy  tend- 
ency toward  dissipation.  In  another  part  of 
this  book  I  make  extensive  reference  to  the  fact 
that  nowhere  in  the  text-books  by  means  of 
which  the  medical  students  of  the  world  receive 
their  education  is  any  proper  attention  paid  to 
the  psychology  of  the  drug  habit.  We  may  as- 
sume that  a  doctor,  having  lost  sleep  because  of 
a  difficult  case,  is  confronted  on  his  return  to  his 
office  by  another  that  demands  immediate  and 
skilful  attention.  He  is  tired  and  very  likely 
he  himself  is  ill.  He  cannot  yield  to  his  wor- 
ries or  illness,  as  he  would  demand  one  of  his 
patients  to  yield.  He  must  *' brace  up."  He 
knows  that  in  the  stock  of  habit-forming  drugs 
that  he  uses  in  his  profession  lies  the  material 
which  will  brace  him  up.  He  tries  it;  it  suc- 
ceeds. 

This  doctor  has  begun  to  nibble  at  the  habit, 


DRUG-TAKER  AND  PHYSICIAN     53 

and  lie  does  not  know  his  danger.  He  himself 
does  not  believe  that  one  or  two  or  a  few  doses 
will  fasten  that  habit  npon  him.  He  finds  that 
a  certain  dosage  produces  the  necessary  desired 
result  upon  the  first  day ;  he  is  stimulated  to  new 
efforts  in  behalf  of  his  patients,  and  because 
those  new  efforts  are  the  result  of  stimulation, 
they  produce  abnormal  weariness.  This  ex- 
haustion must  be  overcome,  and  the  result  is  an- 
other dosage  of  the  drug;  and  this  time  the 
dosage  must  be  larger  than  the  first,  for  both 
his  toleration  for  the  drug  and  his  weariness 
have  increased.  Only  a  few  days  of  such  ex- 
periences are  necessary  to  fasten  the  habit  upon 
him. 

I  have  often  endeavored  to  imagine  the  thrill 
of  horror  which  must  chill  a  doctor's  soul  when 
he  finds  that  this  has  happened.  His  position 
is  a  dreadful  one.  He  has  lost  control.  He 
must  tell  no  one,  for  if  he  tells,  disgrace  and  the 
loss  of  his  means  of  livelihood  will  be  but  mat- 
ters of  a  short  time.  He  knows  nothing  of  any 
means  of  real  relief ;  he  cannot  help  himself ;  he 
is  familiar  with  the  dangers  attendant  on  the 
fake  cures  which  are  widely  advertised.  He  is 
confronted  by  a  stone  wall.  He  must  either 
continue   his   dosage,   thus    enabling   him   to 


54  HABITS  THAT  HANDICAP 

keep  on  with  Ms  practice,  or  he  must  accept 
ruin  and  defeat;  and  to  continue  his  dosage  is 
the  easiest  thing  imaginable,  for  the  drug  has 
been  by  law  intrusted  to  his  keeping  and  is  close 
at  hand. 

Another  doctor  who  is  specially  susceptible  to 
drug  addictions  is  the  one  who  has  been  accus- 
tomed to  alcoholic  stimulation.  Any  doctor 
who  drinks  alcohol,  when  he  finds  himself  beset 
by  arduous  labor  involving  loss  of  sleep,  or  is 
confronted  by  cases  of  such  a  complex  nature 
that  they  involve  a  great  deal  of  mental  worry 
on  his  part,  is  likely  to  drink  more  than  usual. 
Thus  work  and  worry,  the  two  things  which 
make  him  most  liable  to  the  evil  effects  of  any 
stimulation,  are  likely  to  drive  him  directly  into 
over-stimulation. 

Over- stimulation  results  in  super-nervous  ex- 
citation. The  victim  finds  himself  unable  to 
sleep,  he  finds  his  hand  tremulous,  he  finds  his 
thoughts  wool-gathering  when  they  should  be 
concentrating  with  intensity  upon  his  work.  In 
his  pocket  case  there  is  his  little  morphine 
bottle ;  he  knows  its  action,  and  when  called  to 
see  a  patient  while  under  the  influence  of  alco- 
holic stimulants  he  attempts  to  steady  himself 
by    the    administration    of    a    small    dosage. 


DEUG-TAKEE  AND  PHYSICIAN     55 

The  result  is  virtually  instantaneous  and  at  first 
marvelously  effective.  He  finds  himself  en- 
abled to  do  better  work  than  he  has  done  for 
years,  and  more  of  it.  The  remedy  seems 
magical ;  he  tries  it  again  and  again.  The  man 
is  lost. 

Such  instances  as  these  have  produced  the 
most  utterly  hopeless  of  the  many  cases  of  drug 
addictions  among  physicians  with  which  I  have 
come  into  contact. 

TYPES  OP  DEUG-TJSEES 

Specially  numerous  among  drug  victims  are 
physicians  in  nose  and  throat  work,  where  they 
make  daily  employment  of  cocaine  solution. 
Some  of  the  most  desperate  cases  of  drug  habit 
that  I  have  ever  seen  among  physicians  have 
come  from  this  class,  made  familiar  with  the 
constant  use  of  the  drug  by  the  necessity  for 
continually  administering  it  to  their  patients. 

Another  physician  who  is  specially  liable  is 
the  man  who  suffers  severe  pain  from  a  physical 
cause  that  he  knows  can  be  removed  only  by  re- 
sorting to  surgery.  The  average  doctor  will 
postpone  a  surgical  operation  upon  himself  until 
his  condition  has  long  passed  the  stage  that  he 
would  consider  perilous  to  any  of  his  patients. 


56  HABITS  THAT  HANDICAP 

Wliile  he  postpones  it  lie  is  suffering,  and  while 
he  suffers  he  may  be  more  than  likely  to  con- 
tinue his  practice  through  reliance  upon  the 
stimulation  and  pain-deadening  qualities  of 
habit-forming  drugs,  concerning  the  true  and 
insidious  nature  of  which  he  usually  knows  no 
more  than  the  average  layman. 

There  have  been  a  few  cases  of  physicians 
who  have  yielded  unworthily  to  drugs  and  opi- 
ates as  a  means  of  dissipation.  I  have  known 
some  physicians,  for  example,  who  have  been 
opium-smokers.  In  the  United  States  the 
opium-smoker  is  invariably  unworthy.  Not 
long  ago  the  New  York  police  raided  the  apart- 
ment of  a  physician  where  were  found  thirty  or 
forty  opium-pipes  and  more  than  a  hundred 
pounds  of  opium,  either  crude  or  prepared  for 
smoking.  I  have  known  fewer  than  half  a  dozen 
physicians  whose  drug  vice  was  purely  social, 
however.  The  victims  of  drug  habit  who 
achieved  it  through  a  tendency  toward  dissipa- 
tion are  almost  invariably  denizens  of  the  un- 
der-world; and  if  it  were  not  for  the  fact  that 
the  contagion  of  their  vice  may  spread,  they 
might  well  be  permitted  by  society  to  drug  them- 
selves to  death  as  speedily  as  possible. 

We   shall   entirely  disregard  the  physician 


DRUa-TAKEE  AND  PHYSICIAN     57 

who  becomes  addicted  to  the  use  of  drugs 
through  unworthy  tendencies,  and  consider 
only  the  dangers  to  the  profession  and  the  pub- 
lic latent  in  the  case  of  the  physician  who  be- 
comes addicted  in  the  less  reprehensible,  but 
more  dangerous,  manner  that  I  have  indicated. 
Not  only  will  such  a  drug  addiction  injure  the 
doctor's  practice  and  threaten  his  career,  but  it 
will  surely  constitute  a  threat  against  the  wel- 
fare of  his  patients  not  included  in  the  possi- 
bility that  through  it  he  may  miss  engagements, 
write  improper  prescriptions,  and  make  mis- 
takes of  many  kinds. 

THE   DKUG-TAKING  PHYSICIAN   A   MENACE 

A  very  serious  danger  lies  in  the  psychology 
of  drug  addictions.  The  person  who  has  taken 
a  habit-forming  drug  for  the  purpose  of  reliev- 
ing his  own  pain,  and  through  it  has  found  that 
relief  which  he  sought,  is  almost  certain  to  be- 
come abnormally  sympathetic  to  the  suffering 
of  others.  It  is  a  curious  fact  that  this  doctor 
will  be  more  than  likely  to  administer  the  drug 
he  uses  to  his  patients,  not  with  malicious,  but 
with  probably  friendly,  intent,  and  that  he  will 
feel  no  scruples  whatsoever  in  acting  as  a  go- 
between  for  drug-users  in  general  who   find 


58  HABITS  THAT  HANDICAP 

themselves  unable  to   obtain   supplies   easily. 
He  will  do  what  he  can  to  help  confirmed  users 
to  obtain  their  drugs,  even  if  he  makes  no  profit 
out  of  it.    He  will  write  prescriptions  for  them 
in  evasion,  if  not  in  violation,  of  the  law.    It  is 
a  curious  and  tragic  fact  that  the  drug-taking 
doctor  will  spread  the  habit  in  his  own  family. 
There  have  been  many  instances  in  my  hos- 
pital when  I  have  had  a  physician  and  his  wife 
as  patients  at  the  same  time  and  on  the  same 
floor.    In  every  one  of  these  instances  the  drug 
addiction  of  a  wife  has  been  the  direct  result  of 
constant    association   with    the    drug-addicted 
husband.    No  more  dangerous  detail  exists  in 
the  psychology  of  drug-users  than  their  almost 
invariable  tolerance  for  the  habit  in  others  and 
their  sympathetic  willingness  to  promote  its 
spread  among  those  who  suffer  pain.    In  the 
under-world  the  drug  habit  never  travels  alone. 
Through  it  the  woman  who  is  a  drug-user  holds 
the  man  whom  she  desires ;  through  it  the  male 
drug-taker  holds  the  woman  whose  companion- 
ship he  finds  agreeable.    It  is  a  curious  fact 
that  while  in  the  under-world  the  drug  habit  has 
become  a  social  vice,  especially  in  the  case  of 
cocaine,  and  is  frequently  a  proof  of  mixed  sex- 


DEUG-TAKEE  AND  PHYSICIAN     59 

relations,  in  tlie  upper-world  it  is  accompanied 
'by  a  secrecy  of  method  and  sequestration  of 
administration  that  characterizes  no  other  form 
of  vice. 

The  difference  between  the  psychology  of  the 
doctor's  relation  to  the  drug  habit  and  that  of 
the  layman  to  it  may  be  summed  up  in  the  state- 
ment that  while  the  layman  does  not  at  all  know 
what  he  is  getting,  the  doctor  knows  what  he  is 
taking,  but  thinks  that  he  can  stop  taking  it 
whenever  he  feels  ready.  It  is  probable,  there- 
fore, that  the  doctor's  primary  danger  is  as 
great  as  the  layman's,  and  it  is  certainly  true 
that  his  secondary  danger — that  growing  out  of 
the  fact  that  he  has  drugs  and  the  instrument 
for  their  administration  always  ready  to  his 
hand — ^is  very  much  greater. 

The  unnecessary  administration  of  habit- 
forming  drugs  to  the  sick  must  be  legally  pre- 
vented as  far  as  possible.  No  affliction  which 
can  be  added  to  an  already  existing  physical 
trouble  can  compare  in  horror  with  that  of  a 
drug  habit.  Numbers  of  cases  have  come  un- 
der my  observation  in  which  physicians  have 
accomplished  exactly  this  addition  to  the  ruin 
of  their  patients'  health,  to  the  incalculable  dis- 


60  HABITS  THAT  HANDICAP 

tress  of  the  sufferers'  families,  and  to  tlie  vast 
loss  of  society.  In  the  recent  legislation  writ- 
ten upon  the  statute-books  of  New  York  State 
the  first  definite  effort  is  made  to  provide 
against  this  catastrophe. 


CHAPTER  IV 

PSYCH0LCK3Y   AND   DEUGS 

DRUG  babits  may  be  classified  in  three 
groups :  the  first  and  largest  is  created  by 
the  doctor,  the  second  is  created  by  the  drug- 
gist and  the  manufacturer  of  proprietary  and 
patent  medicines,  and  the  third,  and  smallest, 
is  due  to  the  tendency  of  certain  persons  toward 
dissipation. 

The  major  importance  of  the  first  two  groups 
is  due  to  the  fact  that  they  include  by  far  the 
greater  number  of  cases,  and  to  the  pitiful  fact 
that  such  victims  are  always  innocent.  Speak- 
ing generally,  and  happily  omitting  New  York 
State  from  our  statement,  it  is  safe  to  say  that 
the  manufacturer,  the  druggist,  and  the  physi- 
cian are  without  legal  restraint  despite  their 
importance  as  promoters  of  drug  habits,  while 
the  comparatively  unimportant  drug-purveyor 
in  the  under-world  is  held  more  or  less  strictly 
in  control  by  the  police,  and  is  subject  to  severe 

61 


62  HABITS  THAT  HANDICAP 

punisliment  by  the  courts  in  case  of  a  convic- 
tion. 

With  few  exceptions,  the  part  which  the  doc- 
tor plays  in  the  creation  of  drug  habits  is  due 
to  lack  of  knowledge;  but  the  druggist's  part  in 
the  spread  of  this  national  curse  is  purely  com- 
mercial, and  may  justly  be  designated  as  pre- 
meditated. He  always  has  gone  and  always 
will  go  as  far  as  is  permissible  toward  creating 
markets  for  any  of  the  wares  that  he  sells. 

Eegulation  of  the  upper-world  in  regard  to 
the  distribution  of  habit-forming  drugs  will 
automatically  regulate  the  under-world  in  its 
similar  activities.  The  amount  which  will  be 
smuggled  by  those  of  criminal  tendencies  al- 
ways will  be  small  as  compared  with  the  amount 
improperly  distributed  through  channels  now 
recognized  as  legitimate  until  all  the  States 
have  passed  restrictive  legislation  founded 
upon,  modeled  after,  and  cooperative  with  New 
York  State's  legislation;  and  all  this  must  be 
backed  and  buttressed  by  Federal  legislation  of 
a  special  kind  before  real  and  general  good  can 
be  accomplished  in  the  United  States.  Illicit 
drugs  rarely  find  their  way  into  the  possession 
of  users  who  have  acquired  drug  habits  through 
illness  or  pain.    So  it  must  be  admitted  that 


PSYCHOLOGY  AND  DEUGS         63 

most  of  the  effort  that  in  the  past  has  been  made 
toward  restrictive  legislation  has  really  been  de- 
voted to  the  interests  of  the  unworthy  rather 
than  to  those  of  the  worthy.  Save  in  New 
York  State,  the  man  or  woman  with  a  sheep- 
skin— ^the  doctor,  the  druggist,  or  the  nurse — 
remains  virtually  a  free-lance,  permitted  to 
create  the  drug  habit  in  others  or  in  himself 
or  herself  at  will. 

THE  DOCTOR  A  MEANS  OP  SPEEADING  THE  DBI7G 
HABIT 

The  man  in  severe  pain  is  immediately  ex- 
posed, by  the  very  reason  of  his  misfortune,  to 
the  physician  with  a  hypodermic  or  the  druggist 
with  a  headache  powder;  the  man  who  cannot 
sleep  may  at  any  moment  be  made  a  victim  by 
the  physician  whom  in  confidence  he  consults,  or 
by  the  druggist  to  whom  he  may  foolishly  apply 
for  ** something"  which  will  help  him  to  secure 
the  necessary  rest.  Save  in  New  York  State, 
the  druggist's  shelves  are  crowded  with  jars  and 
bottles  holding  dangerous  compounds  which  he 
may  dispense  at  will,  his  drawers  are  crowded 
with  neat  pasteboard  boxes  containing  powders 
which  are  potent  of  great  peril.  The  public  will 
have  made  a  long  step  toward  real  safety  when 


64  HABITS  THAT  HANDICAP 

it  realizes  tliat  any  drug  wliicli  brings  immediate 
relief  from  pain  or  which  will  artificially  pro- 
duce sleep  is  an  exceedingly  dangerous  thing. 

The  sick  man's  confidence  in  his  doctor  is  one 
of  the  doctor's  greatest  assets;  it  has  saved  in- 
numerable lives.  It  is  of  the  same  general  na- 
ture as  the  mysterious  mental  phenomena  which 
frequently  control  physical  conditions,  and 
which  have  been  capitalized  by  various  bodies, 
such  as  Faith  Cure  and  Christian  Science;  but 
if  this  is  an  asset  to  the  physician,  the  general 
public  knowledge  that  he  carries  in  his  case  or 
in  his  pocket  drugs  which  he  can  use  without 
restraint  of  law  for  the  relief  of  pain  may  be- 
come a  general  peril.  In  the  old  days  when  the 
doctor's  work  was  a  mysterious  process,  operat- 
ing by  methods  of  which  he  alone  was  cognizant, 
this  peril  was  less  well  defined;  but  now  that 
the  spread  of  education  has  made  everybody  a 
reader  and  periodical  literature  of  the  times  has 
given  even  children  a  smattering  of  knowledge 
concerning  medical  matters,  the  nature  of  the 
means  by  which  the  doctor  works  his  miracles  is 
well  known,  and  his  unrestraint  may  become  a 
public  penl. 

Of  one  thousand  patients  who  may  consult  the 


PSYCHOLOGY  AND  DEUGS         65 

average  physician,  nine  hundred  and  ninety-nine 
know  perfectly  well  that  he  can  stop  their  pain  if 
he  desires  to  do  so.  Pain  is  unpleasant;  natu- 
rally their  demands  that  he  use  his  power  are 
insistent.  If  he  refuses,  they  are  likely  to  call 
in  another  and  less  scrupulous  physician.  The 
medical  profession  is  overcrowded,  and  perhaps 
the  doctor  needs  the  money.  Even  if  he  is 
swayed  by  nothing  but  financial  need,  he  is  likely 
to  be  tempted  into  the  administration  of  pain- 
deadening  substances  when  his  patient  urges 
him. 

There  is  another  powerful  influence  which 
works  upon  the  most  admirable  of  men — the  pity 
of  the  temperamental  physician  for  the  human 
sufferer.  Most  men  who  choose  the  medical 
profession  as  the  avenue  for  their  life-work  have 
the  qualities  of  mercy,  pity,  and  sympathy 
notably  developed  in  their  psychology.  This  is 
likely  to  induce  them  to  stretch  points  in  favor 
of  relieving  suffering  patients.  Even  when 
their  previous  experience  has  proved  to  them  the 
danger  lying  in  narcotics,  they  are  likely  to  for- 
get it,  or  to  take  a  chance  if  a  special  emergency 
arises.  This  may  be  done  without  great  peril 
to  the  patient. 


66  HABITS  THAT  HANDICAP 

DANGER  OF  THE  KNOWLEDGE  OP  PAIN-EELIEVING 
DKUGS 

The  physician  should  exhaust  every  means 
known  to  medical  science  to  prevent  his  patient 
from  knowing  what  it  is  that  eases  pain  when 
his  practice  makes  it  absolutely  necessary  that 
a  substance  of  the  sort  should  be  administered, 
and  this  is  very  much  less  frequent  than  the 
average  doctor  realizes,  as  will  be  shown  in 
another  passage  of  this  book.  It  is  in  this  neces- 
sity for  concealment  that  the  great  danger  of 
using  the  hypodermic  syringe  as  an  adminis- 
trating instrument  principally  lies.  The  mo- 
ment the  hypodermic  syringe  is  taken  from  the 
doctor's  or  the  nurse's  kit,  the  sufferer  is  made 
aware  of  the  means  which  will  be  used  to  give 
him  ease.  He  remembers  it,  forming  a  respect 
and  admiration,  almost  an  affection,  for  the 
mere  instrument,  and  with  the  most  intense  in- 
terest gathers  such  information  as  he  may  find 
it  possible  to  acquire  about  this  wonder-working 
little  tool  and  the  material  which  is  its  ammu- 
nition of  relief.  He  knows  absolutely  that  the 
relief  which  he  has  found  is  not  due  to  medical 
skill,  but  to  the  potency  of  a  special  drug  admin- 
istered in  a  special  way.    He  stops  guessing  as 


PSYCHOLOGY  AND  DRUGS         67 

to  whether  he  has  been  soothed  by  an  opiate ;  he 
knows  he  has  been. 

It  is  not  only  those  of  weak  psychology  or 
mental  characteristics  who  are  affected  by  this 
knowledge  and  who  through  it  become  drng- 
takers,  though  it  is  the  general  impression  that 
this  is  the  case.  No  impression  was  ever  more 
inaccurate.  The  mentally  strong  and  the  mor- 
ally lofty  are  as  much  averse  to  suffering  physi- 
cal pain  as  the  mentally  weak  and  the  morally 
degenerate.  All  are  in  the  same  class  when  the 
drug  has  been  administered  until  that  point  of 
tolerance  is  reached  where  its  administration 
cannot  be  neglected  without  the  indignant  pro- 
test of  the  physical  body.  That  this  fact  should 
be  impressed  upon  the  medical  profession  as 
a  whole  is  one  of  the  most  needful  things  I 
know. 

Another  hazard  which  the  doctor  runs,  if  he 
passes  the  point  of  extreme  caution  in  the  ad- 
ministration of  drugs  to  patients,  is  the  possibil- 
ity, even  the  probability,  that  through  such  an 
administration  he  will  lose  control  of  his 
patients.  From  the  moment  the  patient  be- 
comes cognizant  of  the  means  which  the  doctor 
has  successfully  used  to  alleviate  his  pain,  he 
begins  to  dictate  to  the  doctor  rather  than  to 


68  HABITS  THAT  HANDICAP 

accept  dictation  from  Mm.  No  doctor  can  con- 
trol a  case  successfully  unless  his  judgment  is 
accepted  as  the  supreme  law  of  treatment.  A 
patient  who  is  not  susceptible  to  the  doctor  ^s 
dictation  cannot  be  expected  to  get  the  full  ad- 
vantage of  the  doctor's  skill  or  knowledge.  If 
diagnosis  shows  that  a  patient  requires  some 
operation,  as  in  certain  uterine  troubles,  or 
more  especially  in  the  case  of  bladder  affections 
or  gall-stones, — cases  in  which  frequently  only 
an  operation  can  give  relief, — and  if  that  patient 
is  aware  that  even  if  the  operation  is  not  per- 
formed, the  doctor  can  still  ease  all  suffering, 
that  patient,  loath  to  run  the  risk  of  the  sur- 
geon's knife,  horrified  by  the  thought  of  hospi- 
tals and  operating  theaters,  is  likely  to  demand 
the  relief  which  opiates  offer,  and  refuse  to  risk 
the  cure  which  surgical  procedure  alone  would 
certainly  afford. 

The  conscientious  doctor  who  insists  upon  the 
proper  course  in  such  a  case  is  seriously  handi- 
capped by  the  presence  in  the  medical  profession 
of  many  men  who  are  less  conscientious,  and 
who  may  yield  more  readily  to  the  urgings  of 
the  patient.  Thus  the  possibility  of  unre- 
stricted use  of  habit-forming  drugs  by  the  med- 
ical profession  becomes  a  handicap  to  the  con- 


PSYCHOLOGY  AND  DRUGS         69 

scientious  man  and  a  commercial  advantage  to 
the  unscrupulous  practitioner. 

UNCONSCIOUS   VICTIMS   OF   THE   DEUG   HABIT 

Episodes  occurring  continually  in  the  course 
of  my  work  add  to  the  strength  of  my  conviction 
of  the  physician's  responsibility.  For  years  not 
a  week  has  passed  which  has  not  brought  me 
patients  with  stories  of  the  maimer  in  which 
they  have  become  victims  of  drug  addiction 
through  the  treatment  of  their  physicians.  Ly- 
ing before  me  as  I  write  is  a  communication 
from  a  young  man  in  Pennsylvania.  He  had 
been  hurt,  and  through  improper  surgical  atten- 
tion a  healing  fracture  had  been  left  intensely 
painful.  The  attending  doctor,  unable  to  cor- 
rect his  imperfect  work,  had  left  with  him  a  box 
of  tablets  to  be  taken  when  the  pain  became 
severe.  Promptly  and  inevitably  the  youth 
achieved  the  drug  habit.  He  felt  disgraced,  he 
would  not  tell  his  father,  his  wife,  or  his  sister. 
His  doctor  could  give  him  no  relief.  By  some 
accident  he  saw  an  article  of  mine  which  was 
published  in  the  *' Century  Magazine,"  and 
made  a  pitiful  appeal  to  me.  I  have  received 
many  such  communications. 

A  pathetic  letter  comes  to  me  from  a  woman 


70  HABITS  THAT!  HANDICAP 

suffering  with  fistula.  Having  achieved  the 
morphine  habit  as  the  direct  and  inevitable  re- 
sult of  taking  pain-killing  drugs  given  to  her  by 
her  family  physician,  she  now  feels  herself  dis- 
graced. Like  many  sensitive  women  who  in  this 
or  some  other  way  become  victims  of  the  drug 
habit,  she  is  obsessed,  as  her  letter  clearly  shows, 
with  the  conviction  that  her  achievement  of 
the  habit  has  been  a  personal  sin,  and  that  her 
continued  yielding  to  it  puts  her  beyond  the 
pale  of  righteousness.  She  writes  that  she 
finds  herself  incapable  of  going  to  her  church 
for  Sunday  services  or  to  prayer  meetings 
because  she  feels  ashamed  when  in  the  im- 
minent presence  of  her  Maker.  Another  woman, 
evidently  animated  by  a  similar  psychological 
phenomenon,  writes  that  having  acquired  the 
drug  habit,  although  blamelessly,  since  it  was 
through  the  administration  of  narcotics  by  her 
doctor,  she  finds  it  a  psychological  impossibility 
to  kneel  at  her  bedside  and  offer  that  prayer  to 
God  which  it  had  been  her  nightly  practice  to 
deliver. 

I  could  multiply  such  instances  indefinitely. 
It  is  impossible  to  conceive  any  episodes  more 
pitiful  than  the  cases  of  this  sort  which 
have  been  detailed  to  me  by  drug  victims, 


PSYCHOLOGY  AND  DRUGS         71 

doctor-made.  That  feeling  of  disgrace,  that  un- 
justified conviction  of  sin  on  the  part  of  abso- 
lutely innocent  women  victims  of  the  drug  habit, 
is  apparently  among  the  most  terrible  of  human- 
ity's psychological  experiences.  If  I  had  the 
pen  of  a  Zola  and  the  imagination  of  a  Maupas- 
sant, I  might  properly  impress  the  medical  world 
with  a  sense  of  its  responsibility  in  this  matter. 
Without  it  I  fear  that  I  may  fail  to  do  so ;  but 
could  I  accomplish  only  this  one  thing,  I  should 
feel  that  my  life  had  been  of  use  to  that  human- 
ity which  I  desire  above  all  things  to  serve. 

No  work  could  be  of  more  importance  to  the 
world  of  sufferers  than  one  which  would  put  the 
use  of  these  potentially  beneficent,  but,  alas! 
often  injurious,  drugs  upon  a  respectable  basis, 
so  that  the  man  who  must  be  given  the  relief 
which  they  alone  can  offer  may  no  more  hesitate 
to  tell  his  neighbor  that  he  is  taking  morphine 
than  he  now  will  hesitate  to  tell  his  neighbor  that 
he  is  taking  blue  mass  pills  or  citrate  of  mag- 
nesia. 

RESPONSIBILITY   OF   THE   TRAINED   NURSE 

That  the  medical  world  should  ever  have  been 
so  lax  in  its  realization  of  its  proper  responsi- 
bility  as   to   allow   trained   nurses   to   carry 


72  HABITS  THAT  HANDICAP 

hypodermic  syringes  and  to  administer  habit- 
forming  drags  seems  to  me  to  be  one  of  the  most 
amazing  things  in  the  world.  No  physician 
who  has  had  an  extensive  experience  with  drug 
addiction  and  who  has  any  conscientious  scru- 
ples whatsoever  will  fail  to  make  sure  before  he 
leaves  a  nurse  in  charge  of  a  patient  that  the 
attendant  possesses  no  habit-forming  drugs  and 
is  without  any  instrument  with  which  they  may 
be  hypodermically  administered.  If  such  drugs 
are  to  be  used,  they  should  be  kept  in  the  phy- 
sician's possession  until  they  are  used,  and 
should  be  administered  by  means  of  an  instru- 
ment which  he  carries  with  him.  When  such 
drugs  are  left,  the  nurse  should  give  an  account- 
ing for  every  fraction  of  a  grain. 

I  have  no  desire  to  convey  the  impression  that 
in  my  opinion  all  nurses  are  untrustworthy  or 
unscrupulous,  but  it  must  be  remembered  of 
them,  as  it  must  be  remembered  of  the  doctor, 
that  they  are  in  the  employ  of  the  patient,  that 
their  income  depends  upon  giving  satisfaction 
to  their  employer,  and  that  they  are  likely  to 
make  almost  any  kind  of  concession  and  resort 
to  almost  any  practice  in  order  to  make  comfort- 
able and  profitable  assignments  last  as  long  as 
possible.    It  is  impossible  not  to  admit  the  truth 


PSYCHOLOGY  AND  DRUGS  73 

of  this  statement,  and  it  must  be  recognized  that 
if  it  is  tme,  a  nurse  is  under  too  great  a  respon- 
sibility when  she  is  in  possession  of  a  hypoder- 
mic kit,  particularly  if  the  patient  knows  that  it 
is  her  kit,  her  hypodermic,  her  drug,  and  that 
she  will  not  be  called  to  account  by  the  physician 
for  such  drugs  as  she  may  administer.  It  must 
be  rather  disconcerting  for  a  physician  to  reflect 
upon  the  fact  that  a  nurse  whom  he  has  left  in 
charge  of  a  critical  case,  through  greed  or  even 
through  the  general  and  admirable  quality  of 
mercy,  is  equipped  for,  and  ignorantly  may  yield 
to  the  temptation  of,  resorting  to  a  practice  that 
may  not  only  undo  all  the  good  his  treatment  has 
accomplished,  but,  in  addition,  may  afflict  the 
patient  with  suffering  more  terrible  than  any 
which  disease  could  give.  This  element  of 
mercy,  soft-heartedness,  and  readiness  to  pity 
must  specially  be  remembered  in  considering  the 
relation  of  the  trained  nurse  to  the  patient.  If 
men  are  often  induced  to  enter  the  medical  pro- 
fession because  of  its  presence  in  their  soul,  even 
more  frequently  are  women  led  by  it  to  become 
trained  nurses.  The  sympathetic  woman  is  even 
more  likely  to  yield  to  the  pleadings  of  suffering 
patients  than  is  the  sympathetic  male  doctor. 
Jt  must  also  be  remembered  that,  like  the  doc- 


74  HABITS  THAT  HANDICAP 

tor,  the  nurse  is  human,  and  neither  iron-nerved 
nor  iron-muscled.  She  is  frequently  under  ter- 
rific strain,  which  makes  her  tend  toward  the 
use  of  stimulants  of  any  kind.  That  which  she 
can  administer  to  herself  by  means  of  the  hypo- 
dermic is  closest  to  her  hand,  is  easiest  to  take, 
and  is  least  likely  to  be  discovered.  Again,  too, 
it  must  be  remembered  that  the  nurse  is  as  sus- 
ceptible to  pain  as  are  the  rest  of  us.  Suffering, 
with  the  means  of  alleviation  at  her  hand,  and, 
like  the  doctor,  ignorant  of  its  true  peril,  what  is 
more  natural  than  that  she  herself  should  use 
the  hypodermic  for  her  own  relief?  Thus  it 
comes  about  that  probably  a  larger  proportion 
of  trained  nurses  than  of  doctors  are  habitual 
drug-users.  This  is  not  a  statement  which  is 
critical  of  the  profession,  for  if  all  mankind 
knew  of  drugs,  had  hypodermics,  and  knew  how 
to  use  them,  a  very  large  proportion  of  the 
human  race  would  resort  to  this  quick  and 
effective,  if  inevitably  perilous,  means  of  finding 
comfort  when  agony  assailed  them. 

The  world  does  not,  the  world  cannot,  under- 
stand that  while  to  the  normal  human  being  the 
worst  that  can  come  is  pain,  the  worst  pain  is 
vastly  less  terrible  than  the  horrors  which  at 
intervals  inevitably  afflict  the  habitual  drug- 


PSYCHOLOGY  AND  DEUGS         75 

user.  Not  one  human  being  who  has  become  a 
victim  of  a  drug  habit  through  its  use  for  the 
alleviation  of  pain  but  will  voluntarily  cry  after 
he  has  come  to  realization  of  the  new  affliction 
which  possesses  him,  ''save  me  from  this  drug 
habit,  and  I  will  cheerfully  endure  the  pain 
which  will  ensue."  The  horror  of  pain  is  not 
so  great  as  the  horror  of  the  drug  habit. 

Another  very  serious  reason  for  extreme 
caution  on  the  part  of  the  medical  profession  in 
regard  to  the  use  of  habit-forming  drugs  is  that 
the  effect  of  such  drugs  upon  a  patient  must 
almost  certainly  make  accurate  diagnosis  of  his 
case  difficult  or  even  impossible.  A  patient 
whose  consciousness  of  pain  is  dulled  or  elim- 
inated by  the  use  of  drugs  cannot  accurately 
describe  to  a  physician  the  most  important 
symptoms  of  his  ailment.  Without  the  assist- 
ance of  such  a  description  the  physician  is  so 
handicapped  that  all  the  skill  which  he  has 
acquired  in  practice  and  all  the  knowledge  he 
has  gained  from  study  are  apt  to  be  of  no  avail. 
Indeed,  in  the  case  of  habitual  drug-users  accu- 
rate diagnosis  of  any  physical  ailment  is  impos- 
sible until  the  effect  of  the  drug  has  been  so  com- 
pletely eliminated  that  not  one  vestige  of  it  re- 
mains. 


CHAPTER  V 

ALCOHOLICS 

I  AM  not  specially  familiar  with  the  statistics 
of  insanity,  but  I  am  inclined  to  believe 
that  an  appreciable  contribution  to  the  total — 
indeed,  one  of  its  largest  parts^ — has  arisen  from 
the  improper  diagnosis  of  drug  and  alcoholic 
cases,  followed  naturally  by  improper  medical 
treatment.  Lack  of  definite  medical  help  in 
cases  of  chronic  alcoholism  is  likely  to  bring 
about  brain  lesions,  which  eventually  mean 
hopeless  insanity. 

For  that  special  reason,  the  chronic  alcoholic 
has  been  the  chief  contributor  to  the  army  of 
the  insane,  and  in  the  asylums  his  presence  is 
notably  frequent  among  the  violent  cases.  The 
head  of  one  of  the  greatest  institutions  in  the 
United  States  for  the  care  of  the  insane  assures 
me  that  this  seems  to  occur  among  women  to  a 
greater  degree  than  with  men. 

One  of  the  most  difficult  problems  of  my  work 
has  been  to  discover  ways  by  which  the  medical 

70 


ALCOHOLICS  77 

profession  can  be  made  to  understand  the  really 
serious  meaning  of  chronic  alcoholism.  Most 
delirium,  the  primary  cause  of  which  lies  in  al- 
coholism, is  amenable  to  treatment. 

EFFECTS  OF  DEPRIVATION  IN  CHRONIC  ALCOHOLISM 

It  is  exhaustion  or  lack  of  alcohol  which  first 
produces  delirium  in  an  alcoholic  case,  whether 
that  exhaustion  is  due  to  the  patient  ^s  inability 
to  assimilate  food  or  alcohol  or  whether  it  is  due 
to  the  fact  that,  being  under  restraint,  alcohol  is 
denied  him. 

In  most  cases  there  is  no  form  of  medication 
which  can  be  successfully  substituted  for  alco- 
hol, and  unless  definite  medical  help  is  provided 
for  the  purpose  of  bringing  about  a  physical 
change  and  thus  avoiding  delirium,  no  course 
remains  safe  except  a  long  and  very  gradual 
process  of  reduction  of  alcoholic  poisoning. 
Such  a  measure  as  this  cannot  be  successfully 
applied  in  the  wards  of  the  general  hospital,  as 
the  mere  fact  that  alcohol  was  there  adminis- 
tered, even  in  slowly  diminishing  doses,  would 
make  such  a  ward  the  chosen  haven  of  innumer- 
able *'old  stagers,"  who,  having  reached  that 
stage  of  worthlessness  which  would  make  it  im- 
possible for  them  to  obtain  the  narcotic  else- 


78  HABITS  THAT  HANDICAP 

where,  would  take  the  treatment  for  the  mere 
sake  of  getting  the  alcohol  of  which  it  princi- 
pally consists. 

Many  friends  of  alcoholic  subjects  and  many 
physicians  in  private  practice  have  believed  that 
they  were  doing  the  alcoholic  a  great  service 
when  they  put  him  where  he  could  not  get  alco- 
hol, and  helped  him  over  the  first  acute  stages 
of  the  period  of  deprivation  by  the  administra- 
tion of  bromide  and  other  sedatives.  This 
usually  means  delirium  first  and  then  a  **wet 
brain";  if  the  patient  survives  this,  his  next 
development  is  more  than  likely  to  be  prolonged 
psychosis,  or,  in  the  end,  permanent  insanity. 
It  is  because  of  this  that  I  consider  the  chronic 
alcoholic  more  clearly  entitled  to  prompt  and 
intelligent  medical  treatment  than  most  other 
sick  persons.  "With  the  alcoholic,  as  with  the 
drug-taker,  the  first  thing  to  be  accomplished  is 
the  unpoisoning  of  the  body.  In  order  to  ac- 
complish this,  it  is  first  necessary  to  keep  up  the 
alcoholic  medication,  with  ample  sedatives,  using 
great  care  lest  the  patient  drift  into  that  ex- 
treme nervous  condition  which  leads  to  de- 
lirium. If  delirium  does  occur,  nothing  but 
sleep  can  bring  about  an  improvement  in  the 
patient's  condition.     This  is  the  point  of  de- 


ALCOHOLICS  79 

velopment  at  which,  physicians  not  properly 
informed  in  regard  to  such  cases  are  likely  to 
employ  large  quantities  of  hypnotics,  and  fre- 
quently this  course  is  followed  until  the  patient 
is  finally  ''knocked  out."  In  many  instances 
an  accumulation  of  hypnotics  in  the  systems  of 
persons  thus  under  treatment  has  proved  fatal. 
I  am  rather  proud  of  my  ability  to  state  that 
from  delirium  tremens  I  have  never  lost  a  single 
case, 

NECESSITY  OF   CLASSIFICATION   OF  ALCOHOLICS 

The  records  show  that  to-day  about  forty  per 
cent,  of  the  insane  in  the  asylums  of  New  York 
State  have  a  definite  alcoholic  history.  In  this 
condition  lies  one  of  the  greatest  opportunities 
ever  offered  to  the  medical  profession.  Even 
now  a  proper  classification  of  the  patients  thus 
immured,  and  their  appropriate  treatment, 
would  in  many  instances  result  in  the  return  to 
the  normal  of  those  affected;  proper  classifica- 
tion and  treatment  at  the  time  when  the  symp- 
toms of  mental  disorder  first  appeared  would 
have  resulted  in  the  salvation  of  innumerable 
cases.  As  a  matter  of  fact,  I  earnestly  believe 
that  if  this  course  was  followed,  the  number  of 
supposedly  permanent  cases  of  insanity  arising 


80  HABITS  THAT  HANDICAP 

from  alcoholic  and  drug  addictions  might  be  de- 
creased by  seventy-five  per  cent. 

Certain  general  rules  may  be  laid  down. 
There  are  no  circumstances  in  which  it  is  advis- 
able for  a  physician  in  private  practice  to  at- 
tempt to  handle  a  case  of  chronic  alcoholism  in 
the  patient's  own  environment.  Efforts  to  do 
this  are  constantly  made,  with  the  result  that 
many  needlessly  die  from  lack  of  alcohol,  while 
an  even  more  tragic  result  is  the  unnecessary 
entrance,  first  into  the  psychopathic  wards  of 
our  hospitals  and  thence  into  our  asylums  for 
the  insane,  of  innumerable  cases  which  needed 
intelligent  treatment  only  for  alcoholism  or 
drug  addiction.  If  this  treatment  is  neglected, 
the  incarceration  of  these  unfortunates  in  asy- 
lums becomes  necessary,  for  without  question 
their  insanity  is  real  enough. 

UNSCIENTIFIC   METHODS   IN   THE   TREATMENT   OF 
AXiCOHOLISM 

During  the  summer  of  1913  I  visited  a  large 
hospital  in  Edinburgh  and  discussed  alcoholism 
and  its  treatment  with  the  visiting  physician. 

*'We  do  not  have  many  alcoholics  here,"  said 
he. 

"Why?"  I  inquired. 


ALCOHOLICS  81 

**A11  our  hospital  work  is  supported  by  pri- 
vate subscription, ' '  he  answered. 

*  *  Then  there  is  no  place  whatever  in  Scotland 
for  the  care  of  the  acute  alcoholic  case?" 

**No.  If  an  intoxicated  person  is  locked  up 
by  the  police  and  develops  delirium,  he  is  sent 
here,  and  we  do  what  we  can  for  him  by  the  old 
methods." 

"You  offer  no  definite  medical  help  along 
special  lines?" 

*  *  No ;  we  have  none  to  offer.  *  * 

He  showed  me  two  cases  in  the  general  ward ; 
one  man  in  a  strait- jacket  was  in  the  midst  of 
delirium  tremens,  his  face  terribly  suffused. 
He  was  in  a  pitiable  state,  and  nothing  was 
being  done  for  him. 

"What  course  shall  we  foUow?"  the  physi- 
cian inquired. 

"Let  me  see  his  chart,"  I  requested.  After 
I  examined  it,  it  became  immediately  apparent 
that  the  patient's  condition  was  due  to  lack  of 
his  usual  drug.  It  was  his  third  day  in  the 
ward. 

"Nothing  but  sleep  will  save  him,"  I  said, 
and  suggested  medication  which  was  adminis- 
tered. 

In  three  or  four  minutes  the  patient  was  re- 


82  HABITS  THAT  HANDICAP 

laxed  and  taken  out  of  the  strait- jacket.  I 
made  certain  suggestions  regarding  general 
stimulation  for  the  bowels  and  the  kidneys,  and 
diet.  On  the  next  day  I  found  the  patient  im- 
proved after  twelve  or  fifteen  hours  of  sleep, 
and  wholly  free  from  delirium.  His  case  had 
now  become  simply  a  matter  of  recuperation. 

Another  case  had  lived  through  several  days 
of  delirium  tremens,  which  had  been  followed 
by  a  **wet  brain";  the  visiting  physician  con- 
sidered this  patient  a  fit  subject  for  the  psycho- 
pathic ward.  I  asked  the  patient  questions 
about  himself.  He  was  sure  that  he  had  been 
out  the  night  before  and  pointed  out  one  of  the 
internes  as  his  companion  during  the  hours  of 
dissipation.  His  case  was  regarded  at  the  hos- 
pital as  almost  certain  to  end  in  an  asylum.  I 
suggested  treatment  and  within  two  days  the 
man's  mind  had  entirely  cleared  up. 

These  instances  of  successful  and  prompt 
relief  occasioned  considerable  surprise  among 
the  hospital  physicians,  who  frankly  admitted 
that  they  knew  nothing  to  do  except  to  keep  the 
patients  there  under  restraint,  and,  if  necessary, 
feed  them  according  to  existing  rules,  to  keep 
their  bowels  open  and  their  bladders  free,  and 
hope  for  the  best. 


ALCOHOLICS  83 

This  was  an  institution  which  is  supposed  to 
represent  the  best  medical  learning  in  the 
United  Kingdom.  I  found  similar  conditions 
existing  in  the  great  hospitals  of  London,  Paris, 
and  Berlin,  so  that  the  Scotch  institution  is  not 
an  exception  to  the  general  European  rule. 
Everywhere  I  was  frankly  informed  that  the 
medical  staff  knew  of  nothing  to  be  done  in  alco- 
holic cases  beyond  deprivation  and  penalization. 

Nor  have  we  been  more  scientifically  progres- 
sive in  the  United  States.  We  are  following 
virtually  the  same  unenlightened  methods,  and 
it  has  even  been  suggested  that  chronic  alcohol- 
ism be  added  to  the  conditions  which  in  the 
minds  of  some  sociological  thinkers  justify 
sterilization.  How  important  our  shortcoming 
is  may  be  strikingly  illustrated  by  the  statement 
that  alcoholic  patients  comprise  one  third  of  all 
the  cases  admitted  to  Bellevue  Hospital  in  New 
York. 

THE  DIFFICULTY  OF  TEEATMENT  IK  SOME 
ALCOHOLIO   CASES 

The  alcoholic  differs  notably  from  the  person 
addicted  to  drugs.  A  drug-taker,  deprived  of 
his  drug,  will  experience  in  the  early  stages  only 
acute  discomfort  and  a  natural  longing  for  the 


84  HABITS  THAT  HANDICAP 

drug  of  wHcli  lie  has  been  deprived.  His  Tin- 
favorable  symptoms  can  always  be  relieved  by 
the  administration  of  the  drug.  The  chronic 
alcoholic,  however,  deprived  of  the  stimulant, 
often  drifts  into  a  delirium  which  cannot  be  re- 
lieved by  the  administration  of  his  accustomed 
tipple.  No  more  terrible  spectacle  can  be  imag- 
ined by  the  human  mind  than  that  of  an  acute 
case  of  delirium  tremens;  no  patient  needs 
more  careful  watching  in  order  that  unfavor- 
able developments  may  be  avoided;  once  de- 
lirium sets  in,  no  type  of  case  is  medically  so 
difficult  to  handle.  The  man  who  for  long 
periods  has  been  saturated  with  alcohol,  and 
who  is  suddenly  deprived  of  it,  is,  I  think,  more 
to  be  pitied  than  almost  any  one  I  know;  yet 
relatives,  friends,  and  physicians  frequently  fol- 
low exactly  this  course,  and  think  that  by  so 
doing  they  are  rendering  the  patient  a  kindly 
service. 

CAUSES   OF   INSANITY 

In  mentioning  the  causes  of  insanity,  it  is, 
however,  impossible  to  permit  the  impression 
to  be  recorded  that  alcohol  is  the  only  offender. 
My  statement  of  the  part  which  alcohol  plays  in 
supplying  the  population  of  our  mad-houses  has 


ALCOHOLICS  85 

never  been  denied;  but  it  is  also  true  that  the 
use  of  headache  powders  and  other  prepara- 
tions commonly  sold  at  our  drug  stores  and  as 
yet  slightly  or  not  at  all  restricted  by  law,  and 
the  use  of  coffee,  tea,  and  tobacco  in  unre- 
stricted quantity,  also  contribute  their  quota  to 
the  insane.  A  letter  from  the  superintendent  of 
a  certain  state  asylum  tells  me  that  he  has  seen 
many  improvements,  sometimes  even  amounting 
to  cures,  result  from  ten  days  of  fasting.  That 
fasting  really  was  a  process  of  unpoisoning.  In 
such  a  case  the  symptoms  of  insanity  may  be  at- 
tributed to  auto-intoxication,  coming  from  any 
one  of  many  causes,  of  which  alcohol,  tobacco,  or 
even  food  improperly  selected  or  unreasonably 
eaten  may  be  one.  The  physician  can  have  no 
means  of  learning  just  what  method  to  pursue  in 
any  case  of  auto-intoxication  until  the  patient 
has  been  unpoisoned.  If  any  one  of  the  great  gen- 
eral hospitals  would  secure  careful  histories  of 
one  hundred  of  its  patients  and  apply  the  proper 
methods  to  those  who  are  found  to  have  been 
poisoned  by  their  habits,  surprising  results 
would  be  achieved.  It  is  specially  true  that  no 
intelligent  mental  diagnosis  can  be  made  of  any 
patient  who  has  had  an  unfavorable  drug,  alco- 
holic, or  even  tobacco,  tea,  or  coffee  history  until 


86  HABITS  THAT  HANDICAP 

lie  has  been  freed  from  the  effects  of  these  drugs 
or  stimulants.  The  first  thing  that  a  physician 
must  do  when  confronted  by  a  case  of  alcoholic 
or  drug  addiction  is  to  learn  whether  it  is  acute 
or  chronic.  If  the  case  is  chronic,  the  patient 
must  not  be  suddenly  deprived  of  his  stimulants. 


CHAPTER  VI 

HELP   FOE   THE   HAED  DEINKEK 

THE  people  of  the  world  in  general,  and 
especially  the  people  of  the  United  States, 
are  asking  more  questions  about  the  cost  of  alco- 
hol— ^not  its  cost  in  money,  but  its  cost  in  men. 
These  are  questions  which  statistics  cannot 
answer,  which,  indeed,  can  never  be  definitely 
answered;  but  we  know  enough  to  be  assured 
that  if  answers  could  be  given,  they  would  be 
appalling.  With  increasing  unanimity  the 
thinkers  of  the  whole  world  are  saying  that  in 
alcohol  is  found  the  greatest  of  humanity's 
curses.  It  does  no  good  whatever;  it  does  in- 
calculable harm.  A  dozen  substitutes  may  be 
found  for  it  in  every  useful  purpose  which  it 
serves  in  medicine,  mechanics,  and  the  arts ;  its 
food  value,  of  which  much  has  recently  been 
said,  is  not  needed;  and  it  has  worked  greater 
havoc  in  the  aggregate  than  all  the  plagues.  If 
not  another  drop  of  it  should  ever  be  distilled, 
the  world  would  be  the  gainer,  not  the  loser, 

87 


88  HABITS  THAT  HANDICAP 

through  the  circumstance.  Yet  the  use  of  alco- 
hol as  a  beverage  is  continually  increasing. 
The  number  of  its  victims  sums  up  a  growing 
total.  Sentimentalists  have  failed  to  cope  with 
it,  and  the  law  has  failed  to  cope  with  it.  In 
combating  it,  the  world  must  now  find  some 
method  more  effective  than  any  it  has  yet  em- 
ployed. 

When  we  consider  excessive  drinkers  as  a 
class,  we  find  that  a  large  number  of  alcoholics 
are  bom  with  tendencies  which  make  alcohol 
their  natural  and  almost  inevitable  recourse. 
As  a  rule  they  are  naturally  highly  nervous,  or, 
through  some  systemic  defect,  crave  abnormally 
the  excitation  which  alcohol  confers.  For  these 
reasons,  granting  favorable  opportunity  and  no 
great  counterbalancing  check,  they  are  fore- 
doomed to  drink  to  excess.  Some  are  predis- 
posed to  alcoholism  by  an  unstable  nervous 
organism  bequeathed  to  them  by  intemperate 
parents  or  other  ancestors ;  others  are  drinkers 
because  they  do  not  get  enough  to  eat,  or  fail, 
for  other  reasons  than  poverty,  to  be  sufficiently 
nourished;  and  others,  possessing  just  the  fa- 
vorable type  of  physique,  become  alcoholics 
through  worry  or  grief.  All  these  kinds  of 
people  a,re  victims  of  a  habit  which,  properly 


HELP  FOR  THE  HAED  DRINKER  89 

speaking,  they  did  not  initiate,  and  of  which, 
therefore,  censure  must  be  very  largely  tem- 
pered. Yet  they  are  generally  treated  as 
though  they  had  perversely  brought  about  their 
own  disease,  a  course  not  more  reasonable  than 
the  punishment  of  people  for  developing  neph- 
ritis or  cancer. 

The  demand  for  a  more  effective  as  well  as  a 
more  logical  treatment  of  alcoholism  has  even 
greater  urgency  than  comes  out  of  this  injustice. 
Much  of  our  best  material  falls  victim  to  this 
disease.  By  general  admission  the  alcoholic 
often  possesses  many  qualities  of  mind  and  tem- 
perament which  the  world  admires  and  pro- 
nounces of  the  utmost  value  when  rightly  devel- 
oped. Even  the  careless  weakling  who  drinks 
to  excess  is  proverbially  likely  to  be  generous, 
magnanimous,  warmly  impulsive,  even  quixotic. 
The  finest  sensibilities,  the  most  delicate  percep- 
tions, and  the  most  enthusiastic  temperaments 
— from  all  of  which  qualities  great  constructive 
results  may  be  expected — are  notably  the  most 
exposed  to  alcoholism.  A  far  greater  number 
of  its  victims  than  the  offhand  moralist  is  in- 
clined to  concede  have  admirable  sturdiness  of 
will  and  dogged  persistence.  With  less,  per- 
haps, they  would  not  have  become  excessive 


90  HABITS  THAT  HANDICAP 

drinkers.  They  are  alcoliolics  because  with  the 
help  of  stimulants  they  have  habitually  forced 
themselves  to  overwork,  to  bear  burdens  of  re- 
sponsibility beyond  their  normal  strength,  or  to 
overcome  physical  obstacles,  like  poor  health, 
eye-strain,  and  insufficient  nourishment.  The 
man  who  drinks  is  not  necessarily  depraved; 
but  under  the  influence  of  stimulant  he  is  very 
likely  to  drift  into  associations  and  environ- 
ments which  will  lower  his  standards  until  he 
becomes  irresponsible,  unadmirable,  or  even 
criminal. 

AEB  AliCOHOLICS   GETTING  A   FAIE   CHANCE? 

It  is  perhaps  not  going  too  far  to  say  that 
most  alcoholics  have  not  been  given  a  fair 
chance  by  their  bodies,  their  temperaments,  or 
the  actual  conditions  of  their  lives.  The  ques- 
tion is,  Are  they  getting  a  fair  chance  from  so- 
ciety— society  whose  experience  has  demon- 
strated that  it  must  in  some  way  protect  itself 
from  them? 

At  present  the  only  public  recognition  of  the 
alcoholic  is  manifested  through  some  form  of 
penalization.  He  loses  his  employment,  he  is 
excluded  from  respectable  society,  in  extreme 
cases  he  is  taken  into  court  and  subjected  to 


HELP  FOE  THE  HAED  DEINKEE     91 

reprimand,  fine,  or  imprisonment.  Nothing  is 
done  to  bring  about  bis  reform  except  as  the 
moral  weight  of  the  non-remedial  punishment 
may  arouse  him  to  his  peril  and  set  his  own  will 
at  work.  Instances  where  this  occurs  are  rare, 
because  the  crisis  always  comes  when,  through 
the  influence  which  alcohol  has  wrought  upon 
him,  his  brain  has  been  befogged  and  his  will 
weakened.  Society  does  virtually  nothing  to 
awaken  that  will  or  to  assist  its  operation.  The 
man  whose  drinking  has  so  disarranged  him 
physically  or  mentally  that  he  is  obviously  ill  is, 
it  is  true,  taken  to  the  alcoholic  ward  of  some 
hospital,  but  even  there  no  effort  is  made  to 
treat  the  definite  disease  of  alcoholism.  For 
example,  Bellevue  and  Kings  County  hospitals, 
where  New  York's  two  "alcoholic  wards"  exist, 
are  institutions  devoted  specially  to  the  treat- 
ment of  emergency  cases.  As  a  matter  of 
course,  the  alcoholics  taken  to  them  are  merely 
"sobered  up."  As  soon  as  they  are  sobered 
and  have  achieved  sufficient  steadiness  of  nerve 
to  make  their  discharge  possible,  they  are 
turned  out  again  into  the  liquor-ridden  city, 
with  their  craving  for  the  alcohol  which  has  just 
mastered  them  no  weaker,  with  their  resolution 
to  resist  its  urging  no  whit  stronger,  than  they 


92  HABITS  THAT  HANDICAP 

were  before  the  crisis  in  their  alcoholic  history 
engulfed  them.  There  is  as  yet  no  public  in- 
stitution in  New  York  City  where  a  man,  either 
as  a  paying  or  as  a  charity  patient,  may  go  for 
medical  treatment  designed  to  alleviate  the 
craving  for  liquor ;  no  organized  charity  makes 
provision  for  the  medical  treatment  of  the  alco- 
holic. Only  three  States  in  the  Union  attempt 
to  provide  more  competently  than  New  York 
State  does  for  this  class  of  unfortunates.  The 
provision  they  make  progressively  treats  men 
convicted  of  drunkenness  in  the  courts  with  sur- 
veillance, threat,  colonization,  and  finally  per- 
petual exclusion  from  society.  Massachusetts 
has  a  colony  for  inebriates.  New  York  is  devel- 
oping one,  and  Iowa  has  had  one  for  several 
years. 

This,  then,  is  at  present  the  treatment  ac- 
corded by  the  public  to  the  victims  of  this  seri- 
ous disease.  There  are  no  clinics  devoted  to 
the  study  of  alcoholism,  although  it  is  the  ail- 
ment of  probably  one  third  of  the  sick  people 
in  the  world  to-day.  Those  who  feel  disposed 
to  question  this  statement  will  be  convinced  that 
it  is  reasonable  if  they  but  make  a  count  of  the 
private  sanatoriums  dealing  exclusively  with 
alcoholics  in  and  near  New  York,  and,  indeed, 


HELP  FOE  THE  HAED  DEINKEE     93 

dotting  and  surrounding  all  our  large  cities. 
Connecticut,  New  Jersey,  and  Hlinois  will  show 
a  startling  number.  And  it  must  also  be  re- 
membered that  many  of  the  cases  of  disease 
other  than  inebriety  treated  in  all  public  hos- 
pitals have  histories  more  or  less  alcoholic,  and 
that  the  insane  asylums  are  crowded  with  those 
gone  mad  through  drink.  It  is  the  demand  of 
common  sense,  not  of  sentiment  alone,  that  this 
situation  should  be  altered. 

Provision  never  has  been  made  really  to  help 
even  the  man  who,  having  lost  control,  is  anx- 
ious to  regain  it.  Inquire  of  the  United  Chari- 
ties in  New  York  and  of  similar  organizations 
in  other  cities,  and  you  will  learn  that  they  are 
doing  most  intelligent  work  in  the  treatment  of 
tuberculosis,  but  that  alcoholism  is  getting  only 
condemnation  and  punishment,  not  curative 
methods ;  yet  there  probably  are  forty  alcoholics 
to  every  consumptive.  Neglect  is  almost  uni- 
versal, and  where  that  charge  cannot  be 
brought,  there  the  errors  are  incredible  and 
continual.  Many  are  charitable  toward  the 
drunkard,  giving  him  their  dimes  when  he  begs 
for  them,  and  thus  promoting  his  inebriety ;  but 
society  as  a  whole  ignores  him  until  he  forces 
its  attention  through  his  helplessness  or  often 


94  HABITS  THAT  HANDICAP 

througli  some  sin,  which  might  be  more  rightly 
charged  to  alcohol  rather  than  to  any  natural 
criminal  tendency  in  the  man's  nature. 

ALCOHOLICS   SHOULD  BE   TEEATED  AS   INTALn)S 

The  physician,  as  things  are,  can  do  little  with 
the  sufferer  from  any  ailment  if  his  system  at 
the  time  is  impregnated  with  alcohol,  for  the 
alcohol  may  very  likely  prove  an  antidote  to  the 
medicines,  or,  if  it  does  not,  may  prevent  the 
patient  from  taking  them.  An  alcoholic  does 
not  keep  engagements ;  he  cannot  be  expected  to 
take  doses  as  prescribed  by  his  physician.  An 
alcoholic  who  is  also  ill  of  something  else  is 
doubly  ill,  but  he  usually  gets  treatment  only 
for  his  secondary  illness.  No  man  who  has  lost 
control  through  stimulants  is  well,  and  until  he 
has  been  definitely  treated,  he  cannot  be  ex- 
pected to  act  normally.  The  world  does  not  yet 
know  how  to  deal  with  him.  Sequestration  as 
it  is  usually  practised — trips  round  Cape  Horn, 
weeks  spent  in  the  woods  where  liquor  cannot 
be  obtained — ^will  never  do  it.  Not  only  must 
the  physical  yearning  be  eliminated,  but  the 
mental  willingness  to  drink  must  be  destroyed 
before  reform  can  be  accomplished.  It  is  at 
this  point  that  the  sentimentalists  are  wont  to 


HELP  FOE  THE  HAED  DEINKEE  95 

fail.  A  promise  made  by  one  in  whom  the  crav- 
ing for  the  stimulant  exists  cannot  properly  be 
considered  binding,  for  such  a  one  is  not  re- 
sponsible for  what  he  promises.  If  body  proves 
stronger  than  the  mind  in  such  a  battle,  he  is 
merely  an  unfortunate,  not  really  a  liar  or  a 
weakling.  The  world's  loss  through  alcohol 
has  been  incalculable.  No  community  ever  ex- 
isted which  could  afford  to  relinquish  the  serv- 
ices of  all  its  citizens  who  drink  to  excess  or 
even  of  those  who  frequently  get  drunk.  Yet 
society  has  continually  maintained  that  when 
encountering  the  alcoholic  it  has  crime,  not  dis- 
ease, to  deal  with.  Hence  the  crudely  ineffec- 
tive idea  of  penalization  as  a  preventive. 

In  general  the  nearest  approach  which  has 
been  made  toward  physiological  treatment — 
beyond,  of  course,  the  mere  ''sobering  up"  in 
an  occasional  hospital  of  patients  made  deliri- 
ous by  drink — ^has  not  been  through  medicine, 
but  regimen,  and  this  regimen  has  invariably 
included  sudden  enforced  abstinence.  This 
remedy  is  worse  than  the  disease.  It  rarely 
helps  and  sometimes  kills.  I  have  seen  many 
men  who  had  been  pronounced  insane  after 
they  had  been  deprived  of  alcoholic  beverages, 
without  proper  treatment,  but  whose  minds  be- 


96  HABITS  THAT  HANDICAP 

came  perfectly  clear  as  tlie  result  of  the  definite 
medical  care  their  cases  really  required.  Num- 
bers of  far  from  hopeless  alcoholics  are  yearly 
being  sent  to  our  insane  asylums,  where  there  is 
little  chance  of  their  recovery,  I  think.  Fur- 
thermore, by  merely  depriving  an  alcoholic  of 
alcohol  without  eliminating  his  desire  for  it,  we 
are  likely  to  force  him  into  something  worse. 
Thus  the  attempt  to  enforce  abstinence  upon  the 
man  who  wants  to  drink  is  not  only  ineffective, 
but  destructive.  In  making  this  statement  I  do 
not  wish  to  be  understood  as  being  opposed  to 
the  prohibition  of  the  sale  of  alcoholic  bever- 
ages ;  indeed,  I  should  favor  the  most  drastic  re- 
strictions prohibiting  the  sale  of  alcohol.  If 
there  was  never  another  ounce  of  alcohol  manu- 
factured, the  world  would  be  none  the  loser 
either  medicinally  or  commercially.  My  reason 
for  making  this  statement  is  that  prohibition  of 
the  sale  of  alcoholic  beverages  has  been  largely 
defeated  because  there  have  not  been  the  proper 
safeguards  thrown  about  the  manufacture  and 
sale  of  drug-store  concoctions  that  can  be  had 
in  any  quantity  as  substitutes  for  alcoholic 
stimulants ;  and  I  think  the  most  drastic  legisla- 
tion that  could  possibly  be  created  on  this  sub- 
ject should  be  enacted  and  enforced  against  the 


HELP  FOR  THE  HARD  DRINKER     97 

druggists  selling  over  their  counters  such  con- 
coctions. 

The  late  Dr.  Ashbel  P.  Grinnell,  for  seventeen 
years  dean  of  the  Vermont  Medical  College, 
studied  this  phase  of  the  subject,  gathering  in- 
teresting statistics. 

After  Vermont 's  adoption  of  prohibitory  leg- 
islation, he  sent  out  to  wholesale  and  retail  drug 
stores,  general  stores,  and  groceries  that  car- 
ried drugs  as  a  part  of  their  stock  a  letter  in 
which  were  inclosed  blanks  calling  for  specific 
information  concerning  the  sale  of  habit-form- 
ing drugs.  Such  was  his  personal  standing  in 
the  State  that  he  received  responses  from  all 
but  two  or  three  of  those  whom  he  addressed, 
and  these  indicated  that  such  sales  had  swelled 
rapidly  until  they  indicated  a  daily  consump- 
tion equal  to  one  and  one  half  grains  of  opium 
or  its  alkaloids  for  every  man,  woman,  and  child 
in  the  State.  This  vast  increase  in  the  use  of 
dangerous  drugs  he  attributed  solely  to  the  pro- 
hibition of  the  sale  of  liquor.  Thus  it  must  be 
argued  that  the  attempt  to  enforce  abstinence 
upon  the  man  who  wants  to  drink  is  not  only  in- 
effective, but  destructive.  Society  may  thus 
save  itself  from  a  few  drunkards,  but  is  likely  to 
get  lunatics  or  ** drug-fiends"  in  their  places. 


98  HABITS  THAT  HANDICAP 

EEFOEM    CANNOT   BE   ATTAINED   BY   PUNISHMENT 

At  the  foundation  of  tlie  present  treatment  of 
the  alcoholic  is  usually  the  idea  that  threaten- 
ing with  punishment  can  be  effective.  Actual 
experience  and  the  slightest  examination  prove 
this  to  be  preposterous.  Many  a  man  who 
drinks  when  he  knows  he  should  not,  does  so  be- 
cause he  cannot  control  himself,  and  he  who  has 
lost  his  self-control  is  obviously  irresponsible. 
A  threat,  or  the  remembrance  of  a  threat,  can- 
not restrain  him.  A  man  who  had  committed  a 
crime  while  drunk,  but  whose  whole  career  had 
otherwise  been  reputable,  was  sentenced  to  life 
imprisonment.  After  he  had  served  six  years 
his  friends  presented  so  strong  a  case  to  the 
governor  that  he  was  pardoned,  but  with  the 
warning  that  if  he  took  one  drink  he  might  be 
returned  to  prison  to  complete  his  sentence. 
An  excellent  illustration  of  the  slight  influence 
of  fear  upon  the  alcoholic  is  furnished  by  the 
fact  that  within  a  very  short  time  he  was  ar- 
rested for  public  drunkenness.  Punishment 
breeds  rebellion,  and  when  you  make  a  man  re- 
bellious you  are  most  unlikely  to  reform  him. 
Punishment  has  never  yet  cured  a  disease.  The 
inflamed  brain  not  only  carries  grudges,  but  is 


HELP  FOR  THE  HARD  DRINKER  99 

almost  sure  to  intensify  them.  If  a  man  is  dis- 
charged from  his  employment  or  arrested  at  a 
time  when  he  is  in  the  abnormal  alcoholic  state, 
the  effect  on  him  cannot  be  reformatory ;  it  must 
be  to  arouse  his  resentment,  not  his  repentance. 
The  employer  who  discharges  a  good  man  from 
his  position  because  of  drunkenness  not  only 
fails  to  deal  intelligently  with  the  man  or  with 
the  subject,  but  may  very  likely  be  committing  a 
crime  against  society  by  robbing  it  of  a  useful 
citizen  and  at  the  same  time  forcing  a  useless 
one  upon  it.  A  man  taken  to  court  for  drunk- 
enness should  with  great  care  be  properly  classi- 
fied. It  should  be  determined  whether  he  is  an 
habitual  drunkard,  an  occasional  drunkard,  or 
an  accidental  drunkard.  There  may  be  hope 
for  the  occasional  drunkard,  there  is  invariably 
hope  for  the  accidental  drunkard.  If  one  of 
these  is  found  to  have  employment  at  the  time 
of  his  arrest,  great  care  should  be  exercised  not 
to  let  the  fact  that  he  has  been  arrested  preju- 
dice his  employer  against  him,  and  as  far  as 
possible  he  should  be  spared  humiliation. 
Nothing  will  more  quickly  unfit  a  man  for  any- 
thing worth  while  than  humiliation.  To  pun- 
ish such  a  man  with  a  prison  term  will  help  no 
one. 


100        HABITS  THAT  HANDICAP 

ISTeither  should  he  be  sent  back  to  his  liberty 
without  some  recognition  of  the  fact  that  he  has 
been  drunk  and  irresponsible.  Any  police  offi- 
cer, and  more  especially  any  police-court  re- 
porter, will  testify  that  almost  every  man  who, 
having  been  arrested  for  drunk-enness,  is  dis- 
charged from  custody  without  penalty,  for  one 
reason  or  another,  social  position,  political  im- 
portance, or  previous  good  character  record, 
will  find  a  saloon  within  two  blocks  of  the  c'ourt 
and  take  a  drink  on  the  way  home.  He  will 
probably  not  get  drank, — ^the  impression  made 
by  his  arrest  will  remain  too  strong  to  permit 
that, — ^but  he  will  take  a  drink.  And  that  and 
other  drinks  will  help  time  drive  from  his  mind 
the  memory  of  the  arrest,  the  cell,  the  court. 
And  what  is  true  of  him  who  has  been  arrested 
and  discharged  is  also  true  of  him  who  has  been 
arrested  and  imprisoned.  Punishment  fails  ut- 
terly to  "reform"  the  alcoholic. 

Nor  is  colonization  more  effective,  except  for 
the  hopeless  cases.  It  means  segregation.  A 
man  once  said  to  me:  ''I  want  to  be  helped, 
but  not  at  the  cost  of  compulsory  association 
with  others  seeking  help.  I  know  that  to  be 
thrown  into  unavoidable  contact  with  those 
worse  than  myself  would  hopelessly  degrade  me. 


HELP  FOE  THE  HARD  DRINKER     101 

I  should  not  be  willing  to  risk  that,  no  matter 
how  much  good  the  treatment  might  do  me." 
Colonization  of  the  occasional  alcoholic  stamps 
him  only  a  little  less  deeply  than  his  stripes  are 
sure  to  stamp  the  criminal  who  is  sent  to  prison, 
and  its  effects  upon  him  and  his  family  are  not 
more  desirable  than  they  would  be  if  the  process 
made  exactly  that  of  him.  He  is  likely  to  be 
barred  from  employment  after  his  discharge 
from  the  colony,  and  thus  find  it  impossible 
to  reestablish  himself.  Moreover,  during  the 
period  of  sequestration  it  is  difficult  to  devise  a 
plan  for  the  care  of  the  wives  and  children  of 
those  sent  into  seclusion.  At  a  time  when  noth- 
ing in  the  way  of  betterment  can  be  expected  of 
him  unless  he  regains  confidence  in  himself, 
such  treatment  does  not  strengthen,  but 
cripples,  a  man's  spirit.  Surveillance  after  his 
return  will  work  on  his  imagination,  cowing  him 
into  morbidness,  until  that  alone  will  first 
weaken  his  will  and  then  break  it  down.  Too 
great  emphasis,  therefore,  cannot  be  placed 
upon  the  viciousness  of  colonization  for  any  but 
the  first  of  the  three  classes  into  which  I  have 
said  that  all  men  charged  in  court  with  drunken- 
ness should  be  carefully  separated.  Coloniza- 
tion of  the  hopeless  is  advisable  only  because 


102        HAEITS  THAT  HANDICAP 

such  men,  before  they  have  descended  to  that 
stage,  have  cost  their  friends  and  society  all 
that  it  is  advisable  to  spend  on  them.  If  the 
man  who  is  worth  while  is  to  be  saved,  it 
must  be  without  the  application  to  him  of  the 
bi'and. 

So  much  for  the  existing  public  methods  of 
dealing  with  the  alcoholic.  The  most  usual 
private  method  is  for  a  man's  family  or  friends, 
when  he  has  lost  control,  to  send  him  to  some 
place  where  he  can  "get  a  grip  on  himself." 
But  he  often  does  not  receive  in  such  a  place, 
any  more  than  in  the  hospital  or  prison,  that 
specialized  treatment  which  can  make  that 
regained  grip  effective.  G-eneral  treatment,  ac- 
companied by  a  gradual  withdrawal  of  stimu- 
lant, will  restore  his  bodily  strength,  with  the 
result,  in  nine  cases  out  of  ten,  that  when  he 
emerges  from  the  seclusion  he  is  able  to  drink 
more  than  he  was  before  he  was  sequestered, 
and  will  be  sure  to  come  to  grief  more  quickly. 
In  most  cases  his  craving  and  need  for  stimu- 
lant are  in  no  degree  decreased,  and  in  conse- 
quence he  will  frequently  relapse  while  going  to 
the  railway  station  on  the  homeward  journey. 
An  even  graver  danger  is  that,  while  still  in  full 
possession  of  the  alcoholic  habit,  he  will  in  addi- 


HELP  FOR  THE  HARD  DRINKEr.     103 

tion  contract  the  hypodermic  habit,  and  any 
drug  habit  developed  in  the  alcoholic  is  the  most 
difficult  of  cases  to  deal  with  successfully.  If 
he  does  relapse,  his  friends  will  almost  surely 
hold  him  blameworthy  and  impatiently  aban- 
don him  as  hopeless,  believing  everything 
to  have  been  done  which  can  be  done.  In 
reality  nothing  at  all  useful  has  been  done  to 
help  him.  He  is  a  sick  man,  and  no  attack  what- 
ever has  been  made  on  his  disease. 

COMPLETE  MENTAL  CHANGE  MUST  PKECEDB  REFOKM 

This  brings  us  to  the  kernel  of  the  matter. 
No  man  who  has  become  addicted  to  the  use  of 
alcohol  can  possibly  abandon  it  unless  he  has 
first  undergone  a  complete  mental  change,  and 
in  ninety-nine  cases  out  of  a  hundred  this  altera- 
tion of  the  mental  state  will  not  come  until  he 
has  experienced  a  physical  revolution.  The 
reason  for  this  is  simple.  Excessive  use  of  al- 
cohol really  deteriorates  body  and  brain  tissue, 
and  tissue  degeneration  transforms  for  the 
worse  the  entire  physical  and  mental  make-up 
of  a  man.  The  confirmed  alcoholic  is  in  the 
state  which,  save  in  rare  instances,  nothing 
short  of  specialized  medical  treatment  can  cor- 
rect.   Mere  general  building  up  of  bodily  tone 


104        HABITS  THAT  HANDICAP 

is  ^s  ineffective  with  alcoholics  as  is  enforced 
deprivation  or  punisliment. 

I  emphasize  this  point  particularly  because 
many  men  are  afraid  to  take  any  treatment  for 
alcoholism  lest  through  it  they  lose  their  stand- 
ing with  themselves  or  with  their  neighbors. 
Self-respect  must  be  protected  at  every  stage  of 
the  struggle  as  the  patient's  only  hope.  My 
purpose  here  is  to  show  that  the  only  chance  of 
reforming  most  alcoholics  lies  in  giving  them 
opportunity  through  this  physiological  change 
to  reestablish  confidence  in  themselves. 

In  setting  about  the  business  of  treating  an 
alcoholic,  the  first  step  is  to  realize  that  he  is 
in  an  abnormal  mental  state.  To  moralize  or 
to  appeal  in  the  name  of  sentiment  to  a  warped 
and  twisted  mind  is,  I  believe,  sheer  waste  of 
time.  To  the  man  who  has  lost  control,  it  must 
be  first  restored  before  he  can  be  put  to  think- 
ing. You  cannot  expect  the  distorted  alcoholic 
brain  to  be  honest  with  you  or  with  itself. 

I  cannot  emphasize  too  strongly  the  harm  that 
may  come  out  of  simply  depriving  the  chronic 
alcoholic  of  his  stimulant.  I  know  that  there 
are  many  relatives  and  friends  and  even  physi- 
cians who,  out  of  pure  desperation,  feel  that 
they  have  accomplished  much  when  they  are  able 


HELP  FOE  THE  HAED  DEINKEE     105 

to  put  a  man  where  lie  is  unable  to  get  his  drink, 
irrespective  of  the  amount  which  he  has  been 
accustomed  to  take.  I  consider  the  chronic  al- 
coholic one  of  the  most  important  cases  in  medi- 
cine to  deal  with  successfully.  Strange  as  it 
may  seem  to  the  layman, — and  it  is  just  as 
strange  to  the  physician, — to  such  a  case  there 
is  absolutely  no  other  form  of  artificial  stimu- 
lants that  will  take  the  place  of  alcohol,  and 
when  a  patient  is  deprived  of  his  accustomed 
stimulant,  within  twenty-four  hours  he  begins 
to  drift  into  delirium  tremens,  which  means  that 
the  patient  is  a  very  sick  man,  and  unless  he  is 
properly  treated,  will,  if  he  lives  through  the 
active  period  of  delirium,  drift  into  a  "wet 
brain,"  or,  in  other  words,  alcoholic  insanity; 
and  even  if  the  patient  survives  the  latter  ill- 
ness, a  large  percentage  of  such  cases  prove  in 
the  end  to  be  hopelessly  insane,  and  about  eighty 
per  cent,  of  the  delirium  tremens  cases  that  do 
not  get  proper  medical  help  die.  It  is  a  very 
serious  matter  dealing  with  the  chronic  alco- 
holic. Something  definite  must  be  done  for 
such  a  case;  deprivation  is  impossible;  simple 
reduction  is  sometimes  a  failure ;  nothing  short 
of  definite  medical,  hospital  work  will  unpoison 
this  sick  man  and  avoid  the  complications  of  de- 


106        HABITS  THAT  HANDICAP 

lirium,  *'wet  brain,"  or  possible  hopeless  in- 
sanity. 

The  second  step  is  to  give  the  patient  that 
definite  medical  treatment  wliicli  will  correct 
bis  physical  condition.  Once  this  change  has 
been  effected,  you  have  a  man  whose  system  is 
no  longer  crying  out  for  liquor,  with  every 
nerve  a-quiver  for  it,  every  tissue  thirsting  for 
it.  There  have  been  reforms  from  alcoholism 
which  were  not  preceded  by  this  physiological 
change,  but  they  have  been  rare. 

The  physiological  metamorphosis  may  be  ac- 
complished from  without,  by  means  of  treat- 
ment, without  assistance  from  the  patient  other 
than  mere  acquiescence.  The  mental  change 
can  be  assisted  from  without;  it  cannot  be  ac- 
complished or  maintained  by  any  one  except  the 
patient.  Despite  himself  a  man  may  be  success- 
fully treated  for  other  ailments,  but  not  for  al- 
coholism. By  an  intelligent  subsequent  atti- 
tude friends  or  physicians  may  help  to  restore 
self-confidence,  but  that  is  all  they  can  do. 

After  the  desire  for  it  has  once  been  elimi- 
nated, the  patient  cannot  afford  to  take  any 
alcohol  whatever,  and  after  a  proper  change 
of  mental  attitude  he  will  not  wish  to.  From 
alcohol  he  must  abstain  altogether,  even  in  ill- 


HELP  FOE  THE  HAED  DEINKEE     107 

ness.  Let  no  recovered  alcoholic  risk  relapse 
because  alcohol  seems  to  his  physician  to  be  de- 
sirable as  a  medicine.  Indeed,  the  most  ex- 
treme care  should  be  exercised  to  avoid  medi- 
cines containing  alcohol  even  in  small  percent- 
ages, and  this  will  bar  most  of  the  proprietary 
remedies.  When  he  is  hungry,  let  the  recov- 
ered alcoholic  eat ;  when  he  is  weary,  let  him  be 
sure  to  rest;  when  he  feels  ill,  let  him  be  sure 
to  consult  without  delay  a  competent  physician. 
None  of  these  conditions  indicates  a  necessity 
for  alcohol. 

Thus  the  man  who  is  not  hopeless  may  be 
saved.  Society  owes  every  alcoholic  a  fair  op- 
portunity to  reform ;  it  may  be  questioned  if  it 
owes  him  repeated  opportunities.  Many  alco- 
holics never  have  been  and  probably  never  could 
be  useful  citizens.  Waste  of  money  and  emo- 
tion on  them  is  lamentable  to  contemplate;  the 
sums  at  present  thus  hopelessly  thrown  away 
would  aggregate  enough  really  to  restore  every 
alcoholic  actually  curable.  Sentimentalists  do 
not  like  to  admit  the  limitations  of  useful  help, 
but  those  limitations  do  exist,  and  we  should 
reckon  with  them.  If  we  do,  the  man  really 
curable  will  have  all  the  better  chance. 


108        HABITS  THAT  HANDICAP 

A  TEST   OP  THE  WORTHY 

It  is  possible  to  discriminate  between  the 
curable  and  the  incurable  by  the  simplest  of  ex- 
pedients. Usually  the  question,  What  is  this 
man  willing  to  do  in  return  for  help!  will,  with 
its  answer,  also  supply  the  answer  to  the  in- 
quiry as  to  his  future.  No  man  of  sufficient 
mental  fiber  to  make  helping  him  of  any  actual 
value  is  willing  to  accept  charity.  Even  if 
he  finds  himself  at  the  moment  unable  to  re- 
pay the  debt  involved,  he  will  be  anxious  to 
make  it  a  future  obligation.  My  fifteen  years 
of  experience  have  proved  to  me  that  the  sense 
of  personal  obligation  is  of  great  moment  in 
this  matter.  Even  when  it  becomes  necessary 
for  a  relative,  employer,  or  friend  to  assist  a 
patient  by  the  payment  of  his  bills,  it  should 
be  regarded  a  part  of  the  treatment  to  consider 
this  a  loan,  which  must  be  repaid,  and  not  a  gift. 
It  follows,  sadly  enough,  that  the  most  hopeless 
alcoholic  is  the  rich  young  man  to  whom  finan- 
cial obligations  incurred  for  treatment  mean 
nothing  whatsoever,  and  to  whom  responsible 
employment  is  unknown.  Indeed,  it  seems 
well-nigh  impossible  to  reform  the  vagrant  rich. 
The  man  who  thinks  that  giving  up  his  alcohol 


HELP  FOE  THE  HAED  DEINKEE     109 

is  primarily  a  privation,  althougli  he  may  ad- 
mit the  definite  necessity  of  this  privation,  is 
not  likely  to  reform  permanently;  but  there  is 
hope  for  that  one  who  declares  without  apology 
that  drinking  is  a  bad  business  and  that  he 
wishes  to  be  helped  to  stop  it.  I  cannot  say 
with  too  great  emphasis  that  self-respecting 
pride  is  the  main  hope  of  the  alcoholic. 

It  must  not  be  overlooked,  however,  that  it  is 
the  pride  of  the  curable  alcoholic  which  makes 
him  difficult  to  reach.  To  try  to  help  such  a 
man  when  it  is  too  late  is  a  pitiably  usual  ex- 
perience, for  not  until  it  is  too  late  does  the 
pride  of  such  a  man  allow  him  to  apply  for 
help.  The  man  who  says,  *'I  will  not  drink  to- 
day,'^  and  finds  himself  compelled  to;  who 
promises  himself,  but  cannot  keep  his  promise, 
is  the  man  who  most  deserves  help,  and  is  most 
likely  to  yield  some  sort  of  good  return  on  an 
investment  made  in  him.  Indeed,  it  is  the  rare 
alcoholic,  curable  or  incurable,  who  of  his 
own  initiative  submits  himself  to  treatment. 
Friends  must  assist;  but  while  the  importance 
of  such  friendly  service  cannot  be  overesti- 
mated, it  must  be  of  the  right  kind  or  it  will  be 
worse  than  useless.  Friends  of  alcoholics  too 
often  either  sentimentalize  or  bully  when  they 


110        HABITS  THAT  HANDICAP 

go  about  the  task  of  helping,  or  they  allow  too 
little  time  for  the  accomplishment  of  the  reform. 
Successful  business  men  are  specially  likely  to 
act  childishly  when  dealing  with  the  mighty 
problem  of  assisting  alcoholics  to  their  feet. 
They  are  likely  to  affirm  that  there  is  no  excuse 
for  any  man  who  yields  to  drink.  If  they  have 
given  help  before,  they  are  prone  to  call  atten- 
tion to  the  fact  that  their  beneficiary  has  not  rec- 
ompensed their  kindness  by  reforming,  and  de- 
clare, for  instance,  that  they  will  pay  his  board 
another  week,  but  that  will  be  the  end  of  their 
endeavor.  This  spirit — and  it  is  the  usual 
spirit — can  accomplish  nothing ;  and  the  money 
spent  in  this  and  other  ill-considered  and  half- 
hearted efforts  to  save  men  has  not  decreased, 
but  has  increased,  the  dissipation  it  has  sought 
to  stop.  Even  relatives  and  intimate  friends 
are  likely  to  become  weary  of  a  case  which  ship- 
ment to  some  private  institution,  deportation  to 
a  ranch,  or  embarkation  on  a  sailing-vessel  for 
a  long  voyage  has  failed  permanently  to  help. 

Such  treatment  works  no  reforms,  or  almost 
none.  Until  the  cause  of  drinking  is  removed, 
travel  from  one  place  to  another  in  an  effort  to 
obtain  reform  by  breaking  up  old  associations 


HELP  FOR  THE  HABD  DRINKER     111 

will  be  of  no  avail,  but  will,  instead,  repeat  the 
experience  of  tbe  old  woman  in  the  fairy-tale 
wbo  was  bothered  by  a  goblin.  When  she  up- 
rooted herself  from  her  old  home  and  sought 
another,  the  goblin,  hidden  in  a  churn,  went  with 
her.  It  was  the  old  woman,  not  the  cottage,  he 
was  haunting;  it  is  the  man,  not  his  environ- 
ment, in  which  the  alcoholic  habit  finds  its 
stronghold.  When  a  patient  by  intelligent 
treatment  has  been  put  into  a  receptive  state  of 
mind,  he  should  be  told  to  look  up  his  old  asso- 
ciates and  to  them  declare  himself  upon  the 
liquor  question.  If  they  are  friends,  they  will 
congratulate  him ;  if  they  are  not,  he  will  have 
gained  by  making  certain  of  it.  And  there  is 
very  little  danger  that,  after  he  has  seen  them, 
he  will  wish  again  to  make  intimates  of  them ; 
that  after,  in  his  sober  senses,  he  has  examined 
the  surroundings  which  they  frequent,  he  will  be 
willing  to  return  to  them.  Being  himself  nor- 
mal, he  will  wish  for  normal  men  as  friends ;  be- 
ing far  more  fastidious  than  he  was  when  he 
was  alcoholic,  the  old  haunts  will  fill  him  with 
disgust.  This  declaration  of  himself  the  man 
must  himself  make.  Good  friends  may  help 
him  otherwise,  and  chiefly  by  refraining  from 


112        HABITS  THAT  HANDICAP 

the  slightest  thing  which  may  by  any  chance 
tend  to  decrease  his  self-respect  and  his  confi- 
dence in  his  own  power  to  stay  reclaimed. 
What  a  man  needs  is  a  new  mind  on  the  subject. 


CHAPTER  Vn 

CLASSIFICATION-   OF   ALCOHOLICS 

ALCOHOLICS  are  more  easily  classiiSed 
than  drug-takers.  With  few  exceptions, 
alcohol-users  have  their  beginnings  in  social 
drinking.  Not  a  few  women  and  boys  have  had 
their  first  taste  of  alcohol,  and  may  even  have 
acquired  a  definite  alcoholic  habit,  through  the 
small  quantities  administered  as  stimulants  by 
physicians;  bnt  in  a  general  way  it  is  as  easj' 
and  just  to  absolve  the  physician  from  re- 
sponsibility in  the  matter  of  alcoholism  as  it  is 
easy  and  just  to  put  a  heavy  responsibility  upon 
him  in  the  case  of  the  use  of  drugs. 

THE   DEMAND   FOE   STIMULANTS 

In  these  days  all  mankind  searches  for  ex- 
hilaration. The  instinctive  demand  for  it  is  an 
inevitable  result  of  the  artificial  social  system 
which  we  have  built  up.  We  work  beyond  our 
strength,  and  naturally  feel  the  need  of  stimu- 
lants; we  play  beyond  our  strength,  and  as 

113 


114        HABITS  THAT  HANDICAP 

naturally  need  whips  for  our  vitiated  energies. 
The  greatest  social  disaster  of  all  the  ages  oc- 
curred when  first  alcoholic  stimulation,  which  is 
only  one  step  in  advance  of  alcoholic  intoxica- 
tion and  narcotization,  found  its  place  as  an  ad- 
junct of  good-fellowship.  All  humanity  turns 
in  one  way  or  another  to  artificial  stimulants, 
and  while  alcohol  and  narcotics  are  the  worst 
among  these,  we  cannot  slur  the  fact  that  many 
who  would  shun  these  agents  as  they  would  a 
pestilence,  turn  freely  to  milder,  but  not  alto- 
gether harmless,  stimulants,  such  as  tea,  coffee, 
and  tobacco. 

I  do  not  purpose  to  go  into  a  long  dissertation 
upon  the  chemical  peculiarities  of  alcohol ;  I  do 
not  purpose  to  discuss  the  value  or  peril  of  alco- 
hol as  food ;  there  are  plenty  of  published  chap- 
ters telling  exactly  what  alcohol  is.  I  feel  that 
it  is  my  mission  to  do  none  of  these  things,  but 
to  endeavor  to  reveal  to  the  student  the  most 
effective  way  of  dealing  with  a  patient  who  has 
drifted  into  a  definite  alcoholic  addiction. 

THE   MAN"   WHO    CANNOT   BE   SAVED 

It  seems  impossible  to  arouse  any  enthusiasm 
or  sympathy  for  the  human  derelict  whose 
natural  weakness  is  inevitably  such  that  one 


CLASSIFICATION  OF  ALCOHOLICS     115 

taste  of  alcohol  means  a  gallon,  and  final  wreck 
and  ruin.  The  human  cipher,  plus  alcohol  or 
minus  alcohol,  it  matters  not  which,  means 
nothing.  It  may  be  true  that  alcohol  subtracted 
from  nothing  leaves  nothing,  but  it  is  certain 
that  alcohol  added  to  nothing  may  mean  a  peril 
to  society  and  a  serious  charge  upon  it. 

A  man  who  has  achieved  nothing  up  to  the 
point  where  he  has  become  addicted  to  excessive 
alcoholism  will  rarely  repay  the  trouble  in- 
volved in  an  effort  to  preserve  him  from  his 
folly,  although  of  course  his  preservation  from 
it  might  be  of  general  social  service  as  a  means 
of  saving  the  public  money  that  otherwise  might 
be  expended  in  the  reparation  of  the  work  of  his 
destructive  tendencies,  besides  the  public  ex- 
pense involved  in  police,  court,  and  prison  econ- 
omy that  prevents  him  from  the  opportunity  of 
indulgence.  But  thousands  of  decent  men  an- 
nually yield  to  alcohol,  and  are  wrecked  by  it. 
The  decent  and  potentially  valuable  citizen  who 
through  overwork,  worry,  sickness,  sorrow,  or 
even  through  a  mistaken  conception  of  social 
amenities  or  duties,  drifts  into  excessive  alco- 
holism is  a  victim  of  our  imperfect  social  sys- 
tem, and  repays  remedial  effort.  Furthermore, 
such  a  man  is  invariably  savable  if  he  himself 


116        HABITS  THAT  HANDICAP 

applies  for  salvation,  assists  with  his  own  will 
in  its  application  to  his  case,  and  pays  his  own 
money  for  the  cure. 

The  proportion  of  the  cases  that  can  be  saved 
among  the  general  run  of  alcoholics  who  are 
sufficiently  prosperous  or  have  sufficiently  pros- 
perous friends  to  make  them  likely  to  come  un- 
der my  direct  observation  amounts  to  about  one 
quarter  of  the  whole.  It  will  be  observed  that 
this  claim  for  alcoholics  is  far  below  the  claim 
which  I  have  made  for  drug-users. 

Where  it  is  found  that  a  case  of  excessive  al- 
coholism has  grown  out  of  a  lack  of  a  normal 
sense  of  responsibility,  where  excessive  alcohol- 
ism has  reached  the  point  at  which  deteriora- 
tion of  the  moral  nature  has  set  in,  or  where  so- 
cial and  financial  entanglements  already  have 
resulted,  a  problem  is  presented  which  is  com- 
plicated and  even  very  doubtful.  In  such  a  case 
far  more  than  definite  medical  treatment  must 
be  resorted  to  before  a  complete  restoration  of 
the  unfortunate  to  social  usefulness  can  be 
hoped  for.  The  naturally  irresponsible  person 
or  the  person  already  led  into  irresponsibility 
by  alcoholism  may  be  regarded  as  an  almost 
hopeless  proposition.  This  is  peculiarly  the 
case  where  no  financial  obligation  can  be  im- 


CLASSIFICATION  OF  ALCOHOLICS     117 

posed  upon  the  patient  as  a  part  of  the  treat- 
ment. The  very  poor  for  whose  treatment 
some  one  else  must  pay,  and  the  very  rich  to 
whom  the  sum  paid  for  treatment  is  a  matter  of 
no  moment,  are  almost  equally  hopeless.  My 
long  experience  has  taught  me  that  the  man  who 
does  not  feel  a  financial  responsibility  for  that 
which  is  done  for  him  is  usually  the  least  prom- 
ising of  all  the  cases  brought  to  me.  I  have 
found  it  necessary  to  regard  as  a  definite  part 
of  my  treatment  the  imposition  of  a  monetary 
obligation. 

If,  for  example,  the  employee  of  a  person  or  a 
corporation  is  sent  to  me  for  relief  from  alco- 
holic tendencies  by  his  employer  or  employers, 
I  invariably  refuse  to  accept  the  case  unless  it 
is  agreed  that  the  sum  paid  for  the  patient's 
treatment  shall  be  held  against  him  as  an  obli- 
gation to  be  repaid  as  soon  as  possible  to  those 
who  have  advanced  it.  Even  the  man  who  is 
curable  will  fail  in  a  psychological  realiza- 
tion of  the  misfortune  into  which  he  has  actu- 
ally fallen  through  alcoholic  indulgence  unless 
he  himself  must  pay  the  fiddler.  In  the  case  of 
a  working-man  who  is  brought  to  me  for  treat- 
ment by  his  employers,  I  make  a  minimum 
charge  as  a  rule,  but  only  on  the  condition  that 


118        HABITS  THAT  HANDICAP 

with  all  due  speed  it  is  deducted  from  his  pay- 
envelop.  In  the  case  of  men  of  a  higher  order, 
as  professional  employees,  heads  of  depart- 
ments, etc.,  I  insist  in  a  general  way  upon  fol- 
lowing the  same  line  of  procedure.  I  cannot 
too  strongly  emphasize  my  absolute  conviction 
that  it  is  invariably  a  waste  of  money  and  time 
for  an  employer  or  an  employing  company  to 
attempt  to  help  alcoholics  by  means  of  free 
medical  treatments.  No  good  will  come  from 
this  in  the  long  run,  as  it  never  will  prove  to  be 
worth  while.  Thus  we  may  classify  very  rich, 
utterly  poor,  and  irresponsible  inebriates  as 
among  the  hopeless.  From  every  moral,  social, 
and  economic  point  of  view  the  hopeless  inebri- 
ate is  a  liability  to  the  world  at  large.  Throw 
him  in  the  sieve  of  respectability,  and  soon  or 
late  he  will  always  prove  small  enough  to  slip 
through  the  meshes. 

COLONIZATION"   OF   ALCOHOLICS 

Among  such  cases  will  be  found  fit  subjects 
for  colonization,  and  these  are  the  only  ones 
who  should  be  treated  in  this  way.  No  greater 
social  mistake  is  possible  than  the  colonization 
and  segregation,  either  in  sanatoriums  or  inebri- 


CLASSIFICATION  OF  ALCOHOLICS    119 

ate  farms,  of  other  than  utterly  hopeless  alco- 
holic cases.  The  next  greatest  mistake  undoubt- 
edly is  society's  failure  to  segregate  those  who 
are  utterly  beyond  the  pale  of  hope.  These  men 
and  women  will  be  less  of  a  burden  to  their 
friends  and  the  community  after  segregation; 
their  segregated  existence  will  not  constitute  a 
threat  against  society  of  the  present  and  future 
generations.  It  is  my  opinion  that  these 
people,  men  and  women,  rich  and  poor,  should 
be  sterilized  and  put  at  work.  It  is  possible 
that  this  plan,  if  properly  carried  out,  might 
develop  some  institutional  effort  worth  while. 
That  at  present  practised  means  a  waste  of 
time  and  money. 

It  should  be  borne  in  mind  that  deprivation 
never  yet  removed  the  underlying  cause  of  the 
desire  for  alcohol,  no  matter  over  how  long  a 
period  this  deprivation  may  have  extended,  nor 
has  it  ever  removed  the  desire  itself.  These 
things  can  be  brought  about  only  by  the  elimi- 
nation of  the  poison  from  the  victim's  system. 

All  alcoholics,  no  matter  whether  they  are 
preferred  risks  or  hopeless  cases,  whether  they 
are  to  be  returned  to  society  or  isolated  and 
sterilized,  should  be  unpoisoned, 


120        HABITS  THAT  HANDICAP 

SUCCESS  OF  THE  SPECIFIC  TREATMENT 

The  first  exhaustive  test  of  this  treatment  for 
alcoholism  was  made  at  Bellevue  Hospital,  and 
its  results  were  announced  in  a  pamphlet  pub- 
lished by  Dr.  Alexander  Lambert.  The  hos- 
pital in  which  the  work  was  carried  on  was 
without  ideal  facilities ;  overcrowded  wards  and 
an  insufficiency  of  nurses  were  among  the  many 
handicaps.  That  the  results  were  more  hope- 
ful than  anything  theretofore  accomplished  is 
indicated  by  the  following  extracts  from 
articles  by  Dr.  Lambert : 

RESULTS 

I  am  often  asked  as  to  the  success  of  this  treatment 
and  the  percentage  of  patients  who  remain  free  from 
their  addiction.  This  varies  enormously  with  the  in- 
dividual patients  and  one  can  only  judge  from  one's 
experience.  My  personal  experience  is  that  11  per 
cent,  of  the  morphinists  and  12  per  cent,  of  the  alco- 
holists  return  for  treatment.  Doubling  this  percent- 
age it  still  gives  us  75  per  cent,  as  remaining  free  from 
addiction.  Of  these  a  very  high  percentage  are 
known  to  have  stayed  free. 

SCOPE  OF  THE  TREATMENT 

This  treatment  is  not  offered  as  a  cure  of  morphin- 
ism or  as  a  cure  of  delirium  tremens  or  chronic  alco- 


CLASSIFICATION  OF  ALCOHOLICS     121 

holism,  as  I  said  in  the  first  article.  It  will,  however, 
obliterate  the  terrible  craving  that  these  patients  suf- 
fer when,  unaided,  they  endeavor  to  get  off  their  drugs 
or  are  made  to  go  through  the  slow  withdrawal  with- 
out some  medication  to  ease  them.  Compared  with 
the  old  methods  of  either  slow  withdrawal  or  rapid 
withdrawal,  it  is  infinitely  superior.  Deprivation  of 
a  drug  is  in  no  way  equivalent  to  elimination  of  that 
drug  from  the  body.  Deprivation  causes  suffering; 
elimination  relieves  it.  But  neither  this  combination 
of  drugs  nor  any  other  combination  known  to  man  can 
prevent  persons,  after  they  are  free  from  their  addic- 
tion— be  it  alcohol  or  morphin — from  going  out  and 
repoisoning  themselves  by  taking  again  the  drug 
which  has  poisoned  them  and  led  them  on  to  their 
habitual  intoxication. 

There  are  many  more  morphinists  who  have  uncon- 
sciously fallen  under  the  spell  of  the  habit  through 
no  fault  of  their  own,  than  can  be  said  of  alcoholists. 

To  any  one  who  has  ever  tried  to  break  off  a  patient 
by  the  old  withdrawal  methods  when  they  were  taking 
goodly  amounts  of  the  drug,  and  has  struggled  to 
keep  them  free  from  it  after  they  have  ceased  taking 
it,  the  difference  in  the  picture  when  undergoing  the 
treatment  by  this  new  method  is  most  striking. 

With  this  treatment  most  patients  do  not  suffer 
more  than  a  bearable  amount  of  discomfort  of  hot 
flashes,  slight  pains,  and  the  discomfort  of  their 
cathartics.  When  properly  administered,  this  is  the 
full  extent  of  suffering  with  the  majority  of  patients. 
Some  do  not  go  as  far  as  this,  a  few  suffer  more.    But 


122        HABITS  THAT  HANDICAP 

when  improperly  administered,  they  can  suffer  as 
much  by  this  method  as  by  any  other. 

No  test  more  exacting  than  the  one  made  at 
Bellevne  Hospital  could  be  devised.  Most  of 
the  cases  appearing  for  treatment  in  the  wards 
of  that  institution  are  of  the  most  advanced  type, 
for  the  nature  of  the  New  York  hospital  system 
may  be  said  in  a  general  way  to  select  for  Belle- 
vue  the  least  hopeful  patients  coming  from  the 
least  hopeful  classes  of  society.  If,  therefore, 
anything  approaching  permanent  relief  was  se- 
cured for  as  many  as  twenty  out  of  every  one 
hundred  cases,  an  extraordinary  efficiency  was 
indicated. 

Of  course  the  intelligent  reader  will  under- 
stand that  no  man  with  reason  can  claim  for 
any  treatment  the  power  permanently  to  di- 
vorce from  alcohol  a  man  who  does  not  wish  to 
be  divorced  from  it.  To  take  a  man  whose  sys- 
tem has  reached  that  degree  of  craving  for  alco- 
hol that  he  would  sign  away  his  right  to  salva- 
tion in  exchange  for  a  drink  after  a  brief  period 
of  deprivation,  if  he  could  not  otherwise  obtain 
the  alcohol,  and  to  unpoison  him  so  that  he 
feels  no  necessity  or  even  the  slightest  desire 
for  a  drink  or  for  any  stimulant,  is  to  ac- 


CLASSIFICATION  OF  ALCOHOLICS     123 

complisli  a  great  deal  of  good.  It  means  that 
his  nervous  system  has  been  restored  to  some- 
thing nearly  normal,  and  that  he  has  been  given 
a  chance.  The  man  who  has  not  had  this  help 
from  outside  can  do  nothing  for  himself;  but 
having  been  cleared  of  alcoholic  poison,  he  is 
brought  into  a  mental  state  wherein  he  finds  it 
possible  to  estimate  reasonably  the  harm  which 
alcohol  has  done  him.  The  patient  is  then  in  a 
mental  state  that  enables  his  relatives  and 
friends  to  deal  with  him  without  being  forced  to 
estimate  and  allow  for  alcoholic  abnormalities 
in  his  processes  of  thought.  He  is  in  a  physical 
state  that,  although  it  apparently  may  be  worse 
than  that  in  which  the  alcohol  had  placed  him, 
is  nevertheless  one  that  will  enable  his  physi- 
cian to  work  with  him  intelligently. 

Such  an  achievement  seems  a  perfect  piece  of 
medical  work  of  its  kind.  Properly  carried  out, 
my  treatment  will  accomplish  exactly  this  in 
every  instance.  It  will  accomplish  it  within  five 
days  and  very  likely  within  three  days.  I  have 
never  known  it  to  require  a  period  of  more  than 
seven. 

When  this  treatment  is  properly  provided  for 
throughout  the  country,  it  will  be  found  that 


124        HABITS  THAT  HANDICAP 

neither  large  nor  costly  institutions  will  be  nec- 
essary. The  stay  of  every  patient  is  so  brief 
that  in  the  average  community  a  small  institu- 
tion containing  only  a  few  beds  will  be  found 
sufiSciently  large  to  meet  all  local  needs. 

THE   HABITUAL   DBUNKABD  IS   NOT   A   CEIMIITAL 

Legislation  restrictive  of  the  sale  and  use  of 
habit-forming  drugs  is  in  reality  a  dangerous 
experiment  until  other  legislation  that  provides 
for  the  medical  help  of  those  who  would  thus  be 
deprived  has  first  been  written  upon  our  statute- 
books.  I  am  inclined  to  think  that  many  of  the 
failures  which  strew  the  paths  of  experimental- 
ists in  anti-alcohol  movements  have  been  due 
to  a  lack  of  similar  foresight.  The  man  who  is 
penalized  for  drunkenness  will  usually  get 
drunk  again  the  moment  he  finds  himself  at  lib- 
erty to  do  so;  and  this  will  not  be  due  to  any 
natural  depravity  upon  his  part,  but,  rather,  to 
an  almost  inevitable  result  of  the  bodily  crav- 
ing that  thrills  his  every  fiber  and  for  the  relief 
of  which  nothing  whatever  has  been  provided. 
We  shall  never  make  any  serious  progress  in 
dealing  with  the  most  serious  evils  of  alcohol- 
ism until  we  waken  to  the  folly  of  treating  the 
hard  and  habitual  drinker  as  a  criminal,  exact- 


CLASSIFICATION  OF  ALCOHOLICS     125 

ing  from  him  penalties  and  inflicting  upon  him 
disgrace. 

In  every  instance  the  passage  of  restrictive 
legislation  should  be  accompanied  by  the  pass- 
age of  remedial  legislation;  for  provision  for 
the  relief  of  suffering  caused  by  prohibitory 
laws  must  be  provided.  The  courts  should  care- 
fully consider  the  facilities  at  the  disposition  of 
the  communities  in  which  they  labor,  and  in  im- 
posing sentences  they  should  be  careful  not  to 
overtax  them.  It  would  be  better  for  a  com- 
munity to  keep  a  victim  upon  a  steady  diet  of 
alcohol  for  weeks  while  he  was  waiting  for  a 
bed  in  a  curative  institution  than  to  risk  caus- 
ing the  man's  death  or  insanity  by  depriving 
him  of  his  alcohol  until  the  means  for  relieving 
his  system's  acute  demand  for  it  were  at  hand. 
By  following  a  similar  plan,  it  will  be  found  that 
the  evil  of  habit-forming  drugs  can  be  extermi- 
nated in  the  United  States.  Whether  alcohol- 
ism, which  is  a  social  vice,  ever  can  be  similarly 
exterminated  by  like  methods  I  do  not  know; 
but  I  am  convinced  that  an  intelligent  pursuit  of 
such  a  policy  would  do  more  to  accomplish  the 
desired  results  than  ever  has  been  done  by  other 
means. 


126        HABITS  THAT  HANDICAP 

HOW   SOCIETY  TEEATS  THE  VICTIM   OF  ALCOHOL 

The  care  of  the  inebriate  who  already  comes 
Tinder  the  law,  and  who  by  his  habits  forces  his 
way  into  the  state  and  municipal  hospitals, 
forms  one  of  the  great  burdens  npon  society  of 
the  present  day.  It  should  be  regarded  as  one 
of  the  most  important  problems  of  modern 
medicine. 

No  other  class  of  the  sick  includes  so  great  a 
number  of  individual  cases.  We  find,  for  ex- 
ample, the  almost  incredible  fact  staring  us  in 
the  face  that  more  than  one  third  of  all  the  pa- 
tients admitted  to  Bellevue  Hospital  in  New 
York  City  are  sent  there  by  alcohol,  while  less 
than  two  per  cent,  are  sent  there  by  habit-form- 
ing drugs. 

I  am  casting  no  reflection  upon  this  or  any 
other  institution  when  I  say  that  there  and  else- 
where little  understanding  is  shown  in  dealing 
with  these  cases.  As  a  matter  of  fact,  no  in- 
telligence is  anywhere  shown  in  this  matter. 
The  policeman  who  finds  a  drunken  man  or 
woman  on  his  beat  arrests  the  unfortunate  with 
as  much  wrath  and  probably  as  much  brutality 
as  he  would  show  a  burglar  or  a  murderer ;  the 
committing  magistrate  before  whom  the  victim 


CLASSIFICATION  OF  ALCOHOLICS    127 

is  taken  treats  Mm  or  her  precisely  as  he  would 
treat  a  criminal;  in  the  various  penal  institu- 
tions to  which  this  man  or  woman  is  committed 
the  idea  upon  which  their  whole  treatment  is 
based  is  that  of  punishment. 

It  seems  to  me  that  the  imperfections  of  this 
system  might  most  easily  be  corrected  by  the 
committing  magistrates.  It  is  the  largest  prob- 
lem which  confronts  these  officials;  therefore 
they  might  very  well  afford  the  time  necessary 
to  study  it  carefully.  Concerted  action  by  this 
group  of  the  judiciary  might  accomplish  worthy 
results  almost  immediately.  As  matters  are  at 
present  organized,  the  committing  magistrate 
may  do  any  one  of  four  things  with  an  inebriate 
who  has  been  brought  before  him:  he  can  re- 
lease him  without  penalty,  he  can  put  him  on 
probation,  he  can  fine  him,  he  can  imprison  him. 
I  have  yet  to  discover  any  one  capable  of  telling 
me  why  measures  of  this  sort  can  possibly  be 
expected  to  have  a  beneficial  effect  upon  a  per- 
son who  through  over-indulgence  has  set  up  in 
his  system  a  demand  for  alcohol. 

I  have  no  wish  to  appear  publicly  as  the  critic 
of  our  petit  judiciary,  but  no  class  of  men  is 
less  informed  upon  this  subject — ^the  one  sub- 
ject upon  which  they  should  be  best  informed — 


128        HABITS  THAT  HANDICAP 

than  the  committing  magistrates  not  only  of  the 
United  States,  but  of  every  other  country  in  the 
world.  A  year  or  two  ago  I  made  a  somewhat 
comprehensive  European  tour,  and  studied 
carefully  the  methods  of  dealing  with  inebriety. 
Nowhere  did  I  find  the  faintest  indication  of  a 
tendency  for  real  intelligence  in  regard  to  the 
matter.  We  insist  upon  special  education  for 
the  professors  of  our  colleges ;  yet  the  influence 
of  a  committing  magistrate  upon  the  human  life 
that  is  brought  under  his  direct  sphere  of  in- 
fluence may  be  greater  even  than  that  of  a  col- 
lege professor  or  a  college  student,  and  of  our 
committing  magistrate  we  make  no  educational 
demand  whatsoever,  and  have  never  established 
even  a  minimmn  standard  of  intelligent  infor- 
mation for  our  petit  bench.  It  is  my  belief  that 
expert  sociological  knowledge  should  be  re- 
quired of  every  man  considered  for  the  impor- 
tant post  of  committing  magistrate. 

RESPONSIBILITY   OP   THE   MAGISTEATE 

The  fact  that  in  New  York  State  a  colony  for 
inebriates  has  been  established  by  law  makes 
this  special  knowledge  more  necessary  there 
than  it  was  before.  Wherever  such  institutions 
have  been  founded,  and  the  courts  may  con- 


CLASSIFICATION  OF  ALCOHOLICS     129 

tribute  to  their  population  by  commitment,  an 
unintelligent  magistrate  finds  it  within  his 
power  not  rarely,  but  every  day,  to  do  more 
harm  during  one  session  of  his  court  than  he  is 
likely  to  find  it  within  the  scope  of  his  intelli- 
gence to  do  good  during  the  course  of  a  year's 
sitting.  I  find  it  impossible  to  be  otherwise 
than  bitterly  pessimistic  in  regard  to  the  work 
our  courts  are  doing  with  alcoholics. 

Under  the  New  York  law,  a  man  taken  for  the 
first  time  before  a  magistrate  and  charged  with 
alcoholism  must  either  be  fined  or  told  that  if  he 
again  appears  charged  with  that  offense,  he  will 
be  subject  to  commitment  to  the  inebriate  farm 
for  a  period  of  not  less  than  three  months.  By 
this  procedure  not  one  thing  has  been  accom- 
plished toward  the  salvation  of  the  man.  If  he 
is  not  committed,  but  is  only  threatened  and  or- 
dered to  report  weekly  or  oftener  to  the  proba- 
tion officer  or  the  court  itself,  the  greatest  of 
all  damage  has  been  done,  since  the  man's  pride 
has  been  depreciated.  After  definite  medical 
treatment  has  been  administered  to  an  inebri- 
ate, the  only  other  thing  that  can  be  done  is  to 
make  an  intelligent  appeal  to  his  pride.  In  this 
appeal  is  included  at  least  one  half  the  possibili- 
ties of  his  salvation.    Nowhere  save  in  a  few 


130        HABITS  THAT  HANDICAP 

instances  in  New  York  City  is  the  alcoholic  case 
treated  with  medical  intelligence,  and  nowhere 
in  the  world  is  the  balance  of  the  necessary 
treatment — the  right  appeal  to  pride — carried 
out  with  any  degree  of  common  sense. 

I  find  one  system  of  special  horror  in  this 
treatment  of  inebriates — committing  a  man  for 
three  months,  then  for  six  months,  and  then  for 
twelve.  No  more  certain  means  could  be  de- 
vised to  increase  the  harm  done  by  alcohol  to 
the  community.  Not  only  does  this  course  fail 
to  help  the  man  in  any  measure  whatsoever,  but 
it  increases  the  unspeakable  harm  which  his  mis- 
fortune must  inflict  upon  his  family.  In  most 
instances  such  a  commitment  not  only  means 
the  man's  separation  from  his  means  of  liveli- 
hood for  the  period  of  its  duration,  but  his  dis- 
charge from  it  as  the  result  of  this  utterly  in- 
efficient and  legally  inflicted  disgrace. 

The  whole  effort  of  society  in  dealing  with 
the  alcoholic  should  be  to  prevent  those  things 
which  at  present  are  the  very  ones  which  it  ac- 
complishes— ^mental  depression,  loss  of  pride, 
disgrace,  and  loss  of  social  position.  I  am  in- 
clined to  think  that  as  the  world  grows  older  it 
will  be  more  and  more  convinced  of  the  ineffi- 
ciency of  punishment,  and  more  and  more  aware 


CLASSIFICATION  OF  ALCOHOLICS    131 

of  the  necessity  of  reform  through  helpfulness. 

It  seems  obvious  that  penalization,  probation- 
ary influences,  or  colonization  must  be  utterly 
useless  in  removing  from  a  man's  physical  sys- 
tem the  craving  for  alcohol.  Therefore  it  is 
equally  obvious  that  their  only  successful  mis- 
sion must  be  to  remove  the  victim  of  drink 
from  contact  with  society  for  the  length  of  time 
during  which  his  sentence  is  operative.  The 
man  who  is  in  all  probability  incurable  is  not 
put  permanently  out  of  harm's  way  by  these 
means,  or  placed  where  he  can  do  no  harm ;  the 
man  who  has  good  stuff  in  him  but  who  has 
through  chance  used  drugs  to  excess  upon  one 
or  more  occasion  is  offered  by  these  methods 
nothing  in  the  nature  of  a  fair  show  toward  re- 
gaining his  usefulness. 

I  see  the  possibility  of  many  serious  results 
in  New  York's  board  of  inebriety  plan.  These, 
I  think,  have  their  beginning  principally  in  the 
fact  that  nothing  along  the  line  of  classification 
has  been  devised  or,  as  far  as  I  know,  has  been 
even  suggested.  If  its  work  were  made  effi- 
cient by  means  of  the  adoption  of  a  plan  of 
classification,  this  board  really  might  become  a 
great  boon  to  society.  Suppose  that  instead  of 
penalizing  the  man  who  has  been  taken  before  it 


132         HABITS  THAT  HANDICAP 

for  inebriety,  the  board,  after  intelligent  and  de- 
tailed investigation  has  shown  that  the  man  is 
probably  curable,  should  provide  for  him  the 
necessary  definite  medical  treatment  to  relieve 
his  system  from  the  ill  effects  of  alcohol,  and 
then  should  bring  him  into  contact  with  psy- 
chological and  analytical  minds  capable  of  en- 
forcing upon  him  a  realization  of  the  terrible 
meaning  of  alcoholism.  Without  having  af- 
fected the  man's  pride  it  would  send  him  back 
to  his  family  and  his  task  with  a  cool  brain  and 
a  new  point  of  view.  Would  not  this  be  a 
vastly  better  way  of  dealing  with  him  than  those 
which  are  at  present  followed? 

There  is  no  reason  why  some  small  charge 
should  not  be  enforced  against  such  benefi- 
ciaries of  an  enlightened  public  intelligence  who 
might  be  found  able  to  meet  it.  This  would 
accomplish  two  things :  it  would  reduce  the  pub- 
lic expense  of  the  system  and  it  would  add  very 
greatly  to  the  mental  impression  left  upon  the 
mind  of  the  person  for  whose  benefits  the  State 
was  working.  Furthermore,  if  a  magistrate 
had  once  formed  the  habit  of  feeling  personal 
interest  in  individual  cases  probably  his  first  act 
after  a  man  had  appeared  before  him  would  be 
to  send  for  the  accused's  employer  and  make 


CLASSIFICATION  OF  ALCOHOLICS     133 

the  truth  of  the  situation  clear  to  him.  The 
mere  fact  that  a  man  has  once  been  intoxicated 
should  not  justify  his  discharge  from  employ- 
ment in  which  at  normal  times  he  is  useful  and 
efficient.  Both  for  his  sake  and  for  his  employ- 
er's, efforts  should  be  made  toward  reform;  for 
it  is  not  infrequently  the  case  that  the  man  who 
has  lost  control  through  drink  is  in  normal  con- 
ditions the  best  man  in  the  office,  factory,  or 
workshop.  That  is  one  of  the  chief  tragedies  of 
the  problem  of  alcohol. 

There  is  no  subject  upon  which  society  more 
sadly  needs  enlightenment.  In  this  educa- 
tional process  it  is  probable  that  the  magistrate 
will  be  the  largest  factor.  He  must  realize  that 
he  is  not  society's  instrument  of  vengeance,  but 
society's  instrument  of  helpfulness.  It  should 
be  his  aim  not  to  punish,  but  to  protect  and  pre- 
serve. He  must  realize  that  scientific  knowl- 
edge of  the  problems  which  confront  him  is  as 
necessary  to  his  real  efficiency  as  scientific 
knowledge  is  to  the  analytical  chemist. 

The  heart  of  a  conscientious  magistrate 
should  thrill  with  a  special  sympathy,  should  be 
aware  of  a  great  responsibility,  whenever  there 
appears  for  judgment  in  his  court  a  man  who 
for  the  first  time  has  lost  control  of  himself 


134        HABITS  THAT  HANDICAP 

through  driiib:.  To  mar  this  man  forever  is  an 
easy  task ;  to  make  him  may  be  difficult,  but  it  is 
certainly  not  beyond  the  bounds  of  possibility. 
The  hard  drinker  who  for  the  first  time  is 
haled  into  court  as  the  consequence  of  intoxica- 
tion never  is  willing  to  concede  either  to  him- 
self or  to  others  that  he  needs  help.  His  soul 
revolts  before  the  mere  thought  that  he  has 
more  than  temporarily,  even  momentarily,  lost 
control.  He  is  likely  to  deny  that  he  has  devel- 
oped a  craving  for  alcohol,  and  emphatically 
and  indignantly  to  assert  that  his  drunkenness 
has  been  merely  incidental  to  the  social  spirit, 
an  accident,  and  in  general  a  thing  of  no  pri- 
mary importance.  The  thought  that  without 
help  there  is  even  a  possibility  that  he  may  drift 
from  bad  to  worse  is  abhorrent  to  him,  and  is 
indignantly  repudiated.  He  will  cheerfully  ad- 
mit that  many  other  men  of  his  acquaintance 
have  fallen  victims  to  the  effects  of  alcohol,  but 
he  will  vehemently  deny  the  possibility  of  a 
similar  fall  on  his  own  part.  The  magistrate 
who  thoroughly  understands  all  the  details  of 
the  alcoholic's  psychology,  and  who  is  suffi- 
ciently adroit  of  mind  and  speech  to  take  advan- 
tage of  this  understanding,  giving  the  culprit 
who  has  been  brought  before  him  every  benefit 


CLASSIFICATION  OF  ALCOHOLICS    135 

of  a  carefully  and  intelligently  organized  knowl- 
edge of  alcoholism,  could  not  fail  to  be  one  of 
the  most  useful  of  society's  servants  and  safe- 
guards. 

The  man  or  woman  taken  before  a  magistrate 
as  the  result  of  alcoholic  over-indulgence  offers 
a  peculiarly  perplexing  problem.  Society  has 
placed  itself  in  a  highly  inconsistent  position  as 
regards  its  relation  to  alcohol.  It  permits  a 
man  to  pay  it  for  the  privilege  to  sell  alcohol  to 
any  one  who  asks  for  it,  the  only  restriction  be- 
ing that  he  may  not  sell  it  to  a  person  who  al- 
ready has  ^'had  too  much."  This  leaves  the 
decision  as  to  a  customer's  needs  and  capacity, 
as  well  as  perils,  to  be  rendered  by  the  man  be- 
hind the  bar.  Thus  to  an  extent  we  intrust 
daily  the  destinies  of  an  appreciable  proportion 
of  our  public  to  a  class  of  men  who  certainly 
have  done  little  to  earn  general  confidence.  In 
nearly  every  State,  if  not  in  all,  laws  exist  im- 
posing penalties  upon  the  dealer  in  alcohol  who 
sells  drink  to  a  person  who  is  already  in  a  state 
of  intoxication;  but  a  careful  study  of  the 
records  of  our  courts  would  fail  to  reveal  any 
large  number  of  liquor  dealers  who  have  been 
charged  with  this  offense,  while  it  is  obvious 
that  most  persons  found  upon  the  public  streets 


136        HABITS  THAT  HANDICAP 

or  elsewhere  in  a  state  of  intoxication  must  have 
had  alcohol  served  to  them  at  a  time  when  they 
had  already  ''had  enough."  As  a  matter  of 
fact,  the  intelligent  mind  cannot  fail  to  realize 
that  the  man  who  has  "had  enough"  invariably 
has  had  too  much. 

This  is  only  one  of  many  reflections  which 
must  occur  to  the  inquiring  mind  occupying 
itself  with  this  problem.  We  have  made  innu- 
merable laws  dealing  with,  and  fondly  supposed 
to  control,  the  sale  of  alcoholic  beverages,  but 
as  a  matter  of  fact  only  one  sort  of  law  has 
ever  been  devised  which  possibly  could  control 
it,  and  that  law  provides  for  absolute  prohibi- 
tion. 

THE   NEED   OP  AN   OEGANIZED  EFFORT  TO   HELP 
THE  ALCOHOLIC 

If  the  world  wishes  to  be  relieved  in  any  meas- 
ure from  the  human  waste  attributable  to  alco- 
hol, the  time  must  speedily  arrive  when  munici- 
palities will  recognize  it  as  their  duty  to  provide 
definite  medical  help  for  every  man  who  wishes 
to  be  freed  from  the  craving  for  alcohol,  and 
who  cannot  afford  to  pay  for  treatment.  It 
must  be  recognized  that  it  is  society's  duty  to 
hold  out  this  helping  hand  to  every  man  who  has 


CLASSIFICATION  OF  ALCOHOLICS    137 

a  job  and  is  in  danger  of  losing  it  through  the 
trap  which  society  itself  has  set  for  his  feet  by 
authorizing,  and  thereby  encouraging,  the  sale 
of  alcoholic  intoxicants. 

Notwithstanding  the  presence  in  our  social 
fabric  of  innumerable  charitable  bodies, 
churches,  religious  societies,  and  other  groups 
of  people  who  mean  well  and  work  hard  to  aid 
the  unfortunates,  it  is  a  fact  that  nowhere  in 
the  United  States  or,  as  far  as  I  know,  anywhere 
else  is  there  a  single  organization  which  is  ef- 
fectually working  along  definite  and  intelligent 
lines  for  the  preservation  of  the  endangered  man 
who  is  still  curable. 

No  mother,  wife,  employer,  or  magistrate  can 
effectively  reason  with  a  man  whose  brain  is  be- 
fogged by  alcohol,  for  that  man  cannot  reason 
with  himself.  Tears,  threats  of  imprisonment, 
and  loss  of  position  do  not  have  upon  him  their 
normal  reaction.  He  is  a  sick  man  whose  men- 
tal and  physical  condition  is  abnormal ;  it  must 
be  made  normal  before  anything  real  can  be 
done  toward  his  assistance. 

There  is  but  one  way  out  of  the  sad  muddle 
in  which  alcohol  has  plunged  certain  branches 
of  our  judiciary.  In  every  city  must  be  estab- 
lished emergency  hospital  wards  to  which  com- 


138         HABITS  THAT  HANDICAP 

mitting  magistrates  may  send  persons  with  ex- 
cessive alcoholic  or  drug  histories.  Treatment 
in  these  emergency  wards  will  be  neither  diffi- 
cult nor  costly. 

Once  this  has  been  done,  the  patient  may  be 
returned  to  court,  where  his  clarified  brain  will 
greatly  assist  the  magistrate  in  deciding  upon 
the  proper  course  for  his  assistance  and  the  pro- 
tection of  society. 

The  commitment  of  the  alcoholic  to  an  or- 
dinary penal  institution  is  a  perilous  expedient. 
The  experiences  which  various  authorities  con- 
nected with  the  Department  of  Correction  in  the 
City  of  New  York  have  had  with  drug  and  alco- 
hol smugglers  indicate  a  condition  that  exists 
more  or  less  generally  in  penal  institutions 
throughout  the  country.  The  drug-user  or  alco- 
holic who  has  been  locked  up  in  a  prison  is  in  no 
way  relieved  of  his  craving  for  the  substance 
which  is  harming  him,  and  his  efforts  to  obtain  it 
will  be  desperate.  The  class  of  men  who  sur- 
round him  as  prison  guards  is  not  of  a  high  type. 
If  he  has  money,  they  will  get  it  from  him  if  they 
can ;  and  if  he  has  friends  outside,  especially  if 
they  themselves  be  drug  or  liquor  addicts,  they 
will  attempt  to  smuggle  to  him  what  he  craves. 
Inasmuch  as  it  is  much  easier  to  smuggle  drugs 


CLASSIFICATION  OF  ALCOHOLICS    139 

into  a  prison  than  it  is  alcohol,  many  alcoholics 
have  been  changed  in  prison  to  drng-takers,  and 
after  this  change  the  metamorphosis  for  the 
mere  drunkard  into  an  actual  criminal  has  often 
occurred.  The  administration  of  a  definite 
medical  treatment  should  therefore  be  regarded 
as  imperative  in  all  cases  of  drug  addiction,  and 
in  most  cases  of  alcoholic  addiction  that  appear 
in  our  prisons.  In  the  cases  of  alcoholic  addic- 
tions, imprisonment  should  end,  in  the  case  of 
first  offenders,  with  the  completion  of  the  treat- 
ment and  the  restoration  of  the  subject's  mind 
to  normal. 

I  cannot  too  strongly  or  too  frequently  re- 
iterate the  statement  that  there  is  no  more  des- 
perate illness  than  chronic  alcoholism. 

Purification  from  the  physical  demand  for 
alcohol  at  the  place  of  commitment  of  men 
taken  before  the  courts  upon  the  charge  of  in- 
toxication might  save  the  public  from  a  greater 
burden  than  any  other  available  medical  process. 
Drunkenness  cannot  rightfully  be  considered  as 
a  crime  as  long  as  society  sanctions  the  sale  of 
alcohol  and  profits  by  it;  therefore  the  punish- 
ment of  alcoholics  as  criminals  is  an  intolerable 
injustice.  That  it  is  also  an  economic  waste  is 
as  clearly  apparent. 


CHAPTER  VIII 

THE   INJUKIOUSNESS   OF   TOBACCO 

WHEN  tobacco  was  first  introduced  into 
Europe  the  use  of  it  was  everywhere  re- 
garded as  an  injurious  habit,  and  on  this  account 
for  a  while  it  made  slow  progress.  It  is  no  less 
injurious  now  than  it  ever  was, — ^we  have  simply- 
grown  used  to  it, — and  it  was  only  when  people 
became  used  to  its  injuriousness  that  the  habit 
began  to  make  great  strides.  "We  find  nowadays 
that  smokers  as  well  as  non-smokers  are  sus- 
picious of  any  form  of  tobacco-taking  to  which 
they  have  not  become  used.  Smokers  who  for 
the  first  time  meet  chewers  or  snuffers  or  those 
who  **dip"  tobacco,  as  in  the  South,  are  affected 
unpleasantly.  Smokers  keep  on  finding  chewers 
disgusting,  and  smokers  of  pipes  and  cigars  fre- 
quently object  to  the  odor  of  cigarettes. 

Nothing  more  strikingly  illustrates  how  ad- 
dicted people  may  become  to  a  habit  than  the 
smoking  and  chewing  of  the  traditional  South- 
em  gentleman  of  the  old  school,  whom  any  other 

140 


INJURIOUSNESS  OF  TOBACCO     141 

personal  uncleanliness  would  have  horrified. 
Young  men  most  fastidious  about  their  apparel 
seem  quite  unaware  that  it  is  saturated  with  the 
smell  of  tobacco.  The  odor  of  a  cigarette  is 
probably  as  offensive  to  some  of  those  who  do 
not  smoke  as  any  other  smell  under  heaven. 
Yet  such  is  the  power  of  habit  that  we  tolerate 
all  these  things. 

If  we  could  begin  all  over  again,  we  should 
find  the  same  general  objection  to  smoking  that 
existed  in  Europe  when  the  habit  first  began. 
Our  chief  need,  then,  is  a  new  mind  on  the  sub- 
ject.   How  can  we  get  it? 

The  circumstance  of  my  giving  up  smoking 
eighteen  years  ago  may  have  some  slight  sig- 
nificance in  this  connection.  I  was  smoking 
hard,  and  began  to  have  a  vague  feeling  that  it 
was  hurting  me.  I  had  been  playing  whist  at  a 
late  hour  in  my  room  at  a  hotel,  and  when  I 
finally  went  to  bed  I  could  not  sleep  for  a  long 
while.  I  awoke  with  a  bad  taste  and  a  parched 
mouth  in  a  room  heavy  with  stale  smoke  and  un- 
sightly with  cigar-butts  lying  everywhere.  Sud- 
denly a  disgust  for  the  whole  habit  seized  me, 
and  I  broke  off  at  once  and  completely.  After 
a  week  or  so,  when  the  first  feeling  of  seediness 
and  uneasiness  and  depression  had  worn  away, 


142         HABITS  THAT  HANDICAP 

I  found  my  appetite  and  concentration  and  in- 
itiative increasing.  Yon  will  observe  that  it 
was  not  until  I  began  to  regard  smoking  as 
harmful  that  I  saw  it  was  also  filthy.  I  had  a 
new  mind  on  the  subject. 

I  am  trying  to  give  my  readers  a  new  mind  on 
the  subject,  and  if  they  have  not  come  to  suspect 
the  evil  of  smoking,  they  will  naturally  ask  me 
to  prove  that  it  is  harmful. 

Let  us  begin  at  the  bottom. 

Does  it  do  any  one  any  physical  good  1  Argu- 
ments in  favor  of  tobacco  for  any  physical  rea- 
son are  baseless.  It  does  not  aid  digestion,  pre- 
serve the  teeth,  or  disinfect,  and  it  is  not  a 
remedy  for  anything.  The  good  it  does — and 
no  habit  can  become  general,  of  course,  unless  it 
does  apparent  good — can  only  be  mental.  Let 
me  admit  at  once  that  smoking  confers  mental 
satisfaction.  It  seems  to  give  one  companion- 
ship when  one  has  none,  something  to  do  when 
one  is  bored,  keeps  one  from  feeling  hungry 
when  one  is  hungry,  and  blunts  the  edge  of  hard- 
ship and  worry.  This  sums  up  the  agreeable  re- 
sults of  tobacco.  There  are  one  or  two  more 
specialized  agreeable  results  which  I  exclude  at 
this  moment  because  they  are  only  temporary. 
The  results  I  mention — ^let  me  admit  at  once — 


INJtJRlOUSNESS  OF  TOBACCO    143 

are  real,  and  both  immediate  and  apparent.  On 
the  other  hand,  the  injurious  results,  after  one 
has  become  inured  to  tobacco  poison,  are  both 
unapparent  and  delayed. 

THE  PHYSIOLOGICAL  ACTION"   OF   TOBACCO 

As  to  the  physiological  and  toxic  effects  of 
tobacco  there  is  much  difference  of  opinion. 
Everybody  knows  that  the  first  chew  or  the  first 
smoke  is  apt  to  create  nausea ;  and  that  no  mat- 
ter how  long  a  man  has  been  smoking,  a  little 
lump  of  the  tar  which  has  collected  in  his  pipe 
will  sicken  him.  Nicotine  is  in  itself  highly 
toxic,  but  is  very  volatile  and  is  absorbed  only 
from  the  portion  of  the  cigar  or  cigarette  held 
in  the  mouth.  The  products  of  combustion  of 
tobacco  are  chemical  substances  which  are  also 
toxic,  and  nausea  naturally  stops  the  smoker 
before  symptoms  of  acute  poisoning  result. 
One  must  look,  then,  for  symptoms  of  slow  poi- 
soning. The  popular  belief  that  tobacco  stunts 
growth  is  supported  by  the  fact  that  non-smok- 
ers observed  for  four  years  at  Yale  and  Am- 
herst increased  more  in  weight,  height,  chest- 
girth,  and  lung  capacity  than  smokers  did  in  the 
same  period. 

Every  athlete  knows  that  it  hurts  the  wind; 


144        HABITS  THAT  HANDICAP 

that  is,  injures  the  ability  of  the  heart  to  respond 
quickly  to  extra  work.  It  also  affects  the  pre- 
cision of  eye  and  hand.  A  great  billiard-player 
who  does  not  smoke  once  assured  me  that  he 
felt  sure  of  winning  when  his  opponent  was  a 
smoker.  A  tennis-player  began  to  smoke  at  the 
age  of  twenty-one,  and  found  that  men  whom  he 
had  before  beaten  with  ease  could  now  beat  him. 
Sharp-shooters  and  riflemen  know  that  their 
shooting  is  more  accurate  when  they  do  not 
smoke.  But  you  may  say :  *  *  The  athletes  and 
billiard-players  and  the  rest  are  experts.  I  am 
an  average  man,  making  average  use  of  my 
faculties.  Besides,  I  am  not  contending  that  ex- 
cessive smoking  is  n't  injurious,  and  I  will  even 
concede  that  the  limit  of  excess  varies  with  the 
man.  But  is  it  not  true  that  harmful  results  of 
average  smoking  for  the  average  man  are 
rare  ? ' ' 

In  answer,  let  me  on  my  side  admit  that  they 
are — the  apparent  harmful  results. 

We  are,  however,  very  ignorant  of  the  effect 
of  small,  continued  doses  of  the  various  tobacco 
poisons.  All  drugs  comparatively  harmless, 
such  as  lead,  mercury,  and  arsenic,  produce  a 
highly  injurious  effect  when  taken  in  repeated 
small  doses.    Just  what  effect  the  use  of  tobacco 


INJURIOUSNESS  OF  TOBACCO     145 

engenders  we  cannot  absolutely  know,  but  no 
physician  doubts  that  smoking  may  be  a  factor 
in  almost  any  disease  from  which  his  patient  is 
suffering. 

There  can  be,  for  instance,  no  question  that 
smoke  simply  as  smoke  irritates  the  mucous 
membrane  of  the  bronchial  tubes  and  renders 
them  more  susceptible  to  infections;  by  irri- 
tating the  mucous  membrane  of  the  nose  and 
throat  it  tends  to  produce  catarrh  and  therefore 
catarrhal  deafness.  It  would  therefore  seem 
fair  to  state  that  the  man  who  does  not  use  to- 
bacco is  less  susceptible  to  disease  and  con- 
tagion, and  recovers  more  quickly  from  a  serious 
illness  or  operation.  From  this  we  should  ex- 
pect to  find  that  tobacco  shows  most  in  later  life, 
when  vitality  is  ebbing  and  the  machinery  of  the 
body  is  beginning  to  wear.  It  is  in  his  middle 
age  that  a  man  begins  to  feel  the  harm.  In 
short,  though  we  know  only  the  precise  or  im- 
mediate effect  of  nicotine  and  only  some  of  the 
morhid  processes  which  excessive  smoking  may 
produce,  it  is  likely  that  the  worst  aspect  of  to- 
bacco is  something  that  we  do  not  know  very 
much  about — its  tendency  to  reduce  a  man's 
general  vigor. 

The  dominant  characteristic  of  tobacco  is  the 


146        HABITS  THAT  HANDICAP 

fact  that  it  heigliteiis  blood-pressure.  The  irri- 
tant action  by  which  it  does  this  sometimes  leads 
to  still  more  harmful  results.  Its  second  action 
is  narcotic:  it  lessens  the  connection  between 
nerve-centers  and  the  outside  world.  These  two 
actions  account  for  all  the  good  and  all  the  bad 
effects  of  tobacco.  As  a  narcotic,  it  temporarily 
abolishes  anxiety  and  discomfort  by  making  the 
smoker  care  less  about  what  is  happening  to 
him.  But  it  is  a  well-known  law  of  medicine 
that  all  the  drugs  which  in  the  beginning  lessen 
nerve-action  increase  it  in  the  end.  Thus  smok- 
ing finally  causes  apprehension,  hyper-excita- 
bility, and  muscular  unrest.  Here  this  inevit- 
able law  seems  to  give  contradictory  results. 
Every  physician  knows  that  an  enormous 
amount  of  insomnia  is  relieved  by  smoking, 
even  if  it  is  at  the  expense  of  laziness  the  next 
day;  at  the  same  time  every  physician  knows 
that  most  excessive  smokers  are  troubled  with 
insomnia. 

CIGARETTES 

In  using  tobacco  we  take  the  poison  into  the 
tissues.  The  chewer  and  the  snuffer  get  the 
effect  through  the  tissue  with  which  the  tobacco 
comes  in  contact.    The  cigarette-smoker  almost 


INJUEIOUSNESS  OF  TOBACCO    147 

invariably  inhales,  and  he  gets  the  most  harm 
merely  because  the  bronchial  mucous  membrane 
absorbs  the  poison  most  rapidly.  The  tobacco 
itself  is  no  more  harmful  than  it  is  in  a  pipe  or 
a  cigar.  Indeed,  it  is  often  less  so  in  the  cheaper 
grades,  for,  being  less  pure,  it  contains  less  nico- 
tine. Furthermore,  the  tobacco  is  generally 
drier  in  a  cigarette,  and  for  that  reason  the  com- 
bustion is  better,  for  the  products  of  the  combus- 
tion of  dry  and  damp  tobacco  are  not  the  same. 
But  since  it  is  a  little  difficult  to  inhale  a  pipe  or 
a  cigar  without  choking,  the  smoke  products  of 
a  pipe  or  cigar  are  usually  absorbed  only  by  the 
mouth,  nose,  and  throat,  whereas  the  inhaled 
smoke  of  the  cigarette  is  absorbed  by  the  entire 
area  of  windpipe  and  bronchial  tubes.  If  you 
wish  to  see  how  much  poison  you  inhale,  try 
the  old  experiment  of  puffing  cigarette  smoke 
through  a  handkerchief,  and  then,  having  in- 
haled the  same  amount  of  smoke,  blow  it  out 
again  through  another  portion  of  the  same  hand- 
kerchief. The  difference  in  the  discoloration 
will  be  found  to  be  very  marked.  You  will  note 
that  in  the  second  case  there  is  hardly  any  stain 
on  the  handkerchief :  the  stain  is  on  your  wind- 
pipe and  bronchial  tubes. 
If  a  man  inhales  a  pipe  or  a  cigar,  he  gets 


148         HABITS  THAT  HANDICAP 

more  injury  simply  because  he  gets  stronger  to- 
bacco ;  but  a  man  never  inhales  a  pipe  or  a  cigar 
unless  he  is  a  smoker  of  long  standing  or  unless 
he  has  begun  with  cigarettes.  Besides  allowing 
one  to  inhale,  a  cigarette  engenders  more  mus- 
cular unrest  than  any  other  kind  of  smoke.  Be- 
cause of  its  shortness,  cheapness,  and  conven- 
ience, one  lights  a  cigarette,  throws  it  away,  and 
then  lights  another.  This  spasmodic  process, 
constantly  repeated,  increases  the  smoker's  rest- 
lessness while  at  the  same  time  satisfying  it  with 
a  feeling  that  he  is  doing  something.  Yet  de- 
spite the  fact  that  cigarette-smoking  is  the  worst 
form  of  tobacco  addiction,  virtually  all  boys  who 
smoke  start  with  cigarettes. 

It  is  generally  believed  that  in  the  immature 
the  moderate  use  of  tobacco  stunts  the  normal 
growth  of  the  body  and  mind,  and  causes  vari- 
ous nervous  disturbances,  especially  of  the  heart 
— disturbances  which  it  causes  in  later  life  only 
when  smoking  has  become  excessive.  That  is  to 
say,  though  a  boy's  stomach  grows  tolerant 
of  nicotine  to  the  extent  of  taking  it  without 
protest,  the  rest  of  the  body  keeps  on  protesting. 
Furthermore,  many  business  men  will  teU  you 
that  tobacco  damages  a  boy's  usefulness  in  his 
work.    This  is  necessarily  so,  since  anything 


INJURIOUSNESS  OF  TOBACCO     149 

wMch  lowers  vitality  creates  some  kind  of  in- 
competence. For  the  same  reason  the  boy  who 
smokes  excessively  not  only  is  unable  to  work 
vigorously,  but  he  does  not  wish  to  work  at  all. 
This  result,  apparent  during  growth,  is  only  less 
apparent  after  growth,  when  other  causes  may 
step  in  to  neutralize  it.  Tobacco,  in  bringing 
about  a  depreciation  of  the  nerve-cells,  brings, 
together  with  physical  results  like  insomnia, 
lowered  vitality,  and  restlessness,  their  moral 
counterparts,  like  irritability,  lack  of  concentra- 
tion, desire  to  avoid  responsibility  and  to  travel 
the  road  of  least  resistance.  If  there  were  some 
instrument  to  determine  it,  in  my  opinion  there 
would  be  seen  a  difference  of  fifteen  per  cent,  in 
the  general  efficiency  of  smokers  and  non- 
smokers.  The  time  is  already  at  hand  when 
smokers  will  be  barred  out  of  positions  which 
demand  quick  thought  and  action.  Already  to- 
bacco is  forbidden  during  working  hours  in  the 
[United  States  Steel  Corporation. 

Many  men  were  prejudiced  against  smoking 
until  they  went  to  college.  There  they  found 
themselves  "out  of  it"  because  they  did  not 
smoke.  More  than  that,  they  found  that  the 
smoke  of  social  gatherings  irritated  their  eyes 
and  throat,  and  they  thought  that  smoking  might 


150        HABITS  THAT  HANDICAP 

keep  them  from  finding  other  people 's  smoke  an- 
noying. A  man  who  had  left  off  smoking  told 
me  that  at  the  first  ** smoker"  he  attended  after- 
ward he  found  the  air  offensive  and  his  eyes 
smarting  intolerably,  although  when  he  had  been 
helping  to  create  the  clouds  in  which  they  were 
sitting  he  had  not  noticed  it  at  all.  These  two 
experiences  are  common.  For  this  reason,  the 
social  inducements  to  smoking  are  considerably 
greater  than  those  to  drinking.  The  man  who 
refuses  to  drink  may  feel  as  much  "out  of  it" 
as  the  man  who  refuses  to  smoke,  but  he  has  or- 
dinarily, and  in  the  presence  of  gentlemen,  no 
other  penalty  to  pay.  He  undergoes  no  discom- 
fort in  spending  the  evening  in  a  roomful  of 
drinkers,  and  he  can  manage  to  find  things  to 
drink  that  will  have  for  them  the  semblance  of 
good-fellowship.  It  is  the  social  features  that 
attend  the  acquiring  and  the  leaving-off  the 
habit  which  make  smoking  difficult  to  attack.  In 
its  present  state,  even  if  a  boy  were  thoroughly 
familiarized  in  school  with  the  harm  tobacco 
would  do  him,  he  would  still  be  seduced  by  the 
social  side  of  it.^ 

1 1  have  heard  of  a  New  Yorker  who  gave  up  his  attendance 
as  a  member  of  the  executive  committee  of  a  prominent  and 
very  useful  reform  a-ssociation  because,  though  an  occasional 


INJURIOUSNESS  OF  TOBACCO     151 

When  a  habit  fosters  or  traditionally  accom- 
panies social  intercourse,  it  is  all  the  harder  to 
uproot. 

What  grounded  opium  so  strongly  in  China 
was  its  social  side.  The  Chinese  lacked  social 
occupation,  and  it  was  not  the  custom  of  the 
country  for  a  man  to  find  it  with  his  friends  and 
family,  though  no  people  are  more  socially  in- 
clined. Smoking  opium  became  their  chief  so- 
cial activity;  they  gathered  together  in  the  one 
heated  room  of  the  house  to  gossip  over  their 
pipes.  We  smoke  tobacco  as  the  Chinese  smoke 
opium,  **for  company"  and  in  company.  Thus 
one  must  provide  strong  reasons  to  make  a  man 
give  it  up.  He  will  not  do  so  because  it  costs 
him  something;  he  expects  to  pay  for  his  pleas- 
ures. When  a  man  has  actually  gone  to  pieces, 
it  is  comparatively  easy  to  convince  him  that  he 
ought  to  give  up  what  is  hurting  him;  but  the 
average  man  has  not  been  excessive  enough  for 
that,  and  has  never  brought  himself  to  the  point 
of  serious  conscious  injury.  Even  a  physician 
cannot  with  any  certainty  tell  the  average  mod- 
smoker,  he  could  not  endure  the  tobacco-laden  atmosphere  of 
the  room  where  the  committee  met. 

To  this  day  his  associates  probably  think  him  a  very  luke- 
warm worker  in  the  cause! 


152        HABITS  THAT  HANDICAP 

erate  smoker  whether  tobacco  is  hurting  him. 
Consequently,  if  one  would  make  this  man  stop 
smoking,  especially  when  he  sees  that  leaving 
off  has  caused  some  people  more  apparent  dis- 
comfort than  all  their  smoking  did,  one's  only 
chance  is  to  make  him  change  his  mental  atti- 
tude. I  hope  to  assist  in  doing  this  by  calling 
attention  to  the  fact  that  tobacco  not  only  pre- 
pares the  way  for  physical  diseases  of  all  kinds, 
as  any  physician  will  tell  you,  but  also,  as  long 
investigation  has  shown  me,  for  alcoholism  and 
for  drug-taking. 

TOBACCO,  ALCOHOL,  AND  OPIUM 

The  relation  of  tobacco,  especially  in  the  form 
of  cigarettes,  and  alcohol  and  opium  is  a  very 
close  one.  For  years  I  have  been  dealing  with 
alcoholism  and  morphinism,  have  gone  into  their 
every  phase  and  aspect,  have  kept  careful  and 
minute  details  of  between  six  and  seven  thou- 
sand cases,  and  I  have  never  seen  a  case,  except 
occasionally  with  women,  which  did  not  have  a 
history  of  excessive  tobacco.  It  is  true  that  my 
observations  are  restricted  to  cases  which  need 
medical  help, — ^the  neurotic  temperaments, — ^but 
I  am  prepared  to  say  that  for  the  phlegmatic 
man,  for  the  man  temperamentally  moderate, 


INJUEIOUSNESS  OF  TOBACCO    153 

for  the  outdoor  laborer,  whose  physical  exercise 
tends  to  counteract  the  effect  of  the  tobacco  and 
the  alcohol  he  uses — in  short,  for  all  men,  to- 
bacco is  an  unfavorable  factor  which  predis- 
poses to  worse  habits.  A  boy  always  starts 
smoking  before  he  starts  drinking.  If  he  is  dis- 
posed to  drink,  that  disposition  will  be  increased 
by  smoking,  because  the  action  of  tobacco  makes 
it  normal  for  him  to  feel  the  need  of  stimulation. 
He  is  likely  to  go  to  alcohol  to  soothe  the  mus- 
cular unrest,  to  blunt  the  irritation,  he  has  re- 
ceived from  tobacco.  From  alcohol  he  goes  to 
morphine  for  the  same  reason.  The  nervous 
condition  due  to  excessive  drinking  is  allayed  by 
morphine,  just  as  the  nervous  condition  due  to 
excessive  smoking  is  allayed  by  alcohol.  Mor- 
phine is  the  legitimate  consequence  of  alcohol, 
and  alcohol  is  the  legitimate  consequence  of  to- 
bacco. Cigarettes,  drink,  opium,  is  the  logical 
and  regular  series. 

The  man  predisposed  to  alcohol  by  the  in- 
heritance of  a  nervous  temperament  will,  if  he 
uses  tobacco  at  all,  almost  invariably  use  it  to 
excess ;  and  this  excess  creates  a  restlessness  for 
which  alcohol  is  the  natural  antidote.  The  ex- 
perience of  any  type  of  man  is  that  if  he  takes  a 
drink  when  he  feels  he  has  smoked  too  much,  he 


154        HABITS  THAT  HANDICAP 

finds  he  can  at  once  begin  smoking  all  over 
again.  For  that  reason,  the  two  go  together, 
and  the  neurotic  type  of  man  too  often  combines 
the  two.  Tobacco  thus  develops  the  necessity 
for  alcohol. 

It  is  very  significant  that  in  dealing  with  al- 
coholism no  real  reform  can  be  expected  if  the 
patient  does  not  give  up  tobacco.  Again,  most 
men  who  have  ever  used  alcohol  to  excess,  if  re- 
stricted voluntarily  or  involuntarily,  will  use 
tobacco  to  excess.  This  excess  in  tobacco  pro- 
duces a  narcotic  effect  which  temporarily  blunts 
the  craving  for  alcohol.  Another  way  of  saying 
the  same  thing  is  that  when  smokers  are  drunk 
they  no  longer  care  to  smoke,  a  fact  that  is  a 
matter  of  common  observation.  This  means 
that  there  is  a  nervous  condition  produced  alike 
by  alcohol  and  tobacco.  When  a  man  gets  it 
from  drinking,  he  does  not  keep  on  trying  to  get 
it  from  smoking.  As  well  as  reacting  upon  each 
other,  the  two  habits  keep  each  other  going.  It 
is  not  altogether  by  haphazard  association  that 
saloons  also  sell  cigars;  they  sell  them  for  the 
same  reason  that  they  give  away  pretzels — to 
make  a  man  buy  more  drinks. 

This  relationship  between  tobacco  and  alco- 
holism is  not  understood  by  the  public.    It  has 


INJUEIOUSNESS  OF  TOBACCO    155 

been  absolutely  demonstrated  that  the  continued 
use  of  tobacco  is  a  tremendous  handicap  upon 
the  man  who  is  endeavoring  to  free  himself  from 
the  habit  of  alcoholic  indulgence.  Only  a  man 
of  the  strongest  character  will  persist  in  abstain- 
ing from  alcohol  unless  he  also  abstains  from 
tobacco,  even  after  he  has  undergone  the  most 
intelligent  medical  treatment.  In  the  system  of 
a  man  already  disposed  toward  alcoholic  stim- 
ulation, no  one  thing  will  prove  so  positive  a 
factor  toward  creating  the  sense  of  need  as  the 
use  of  tobacco.  Physiological  action  of  tobacco 
is  to  create  muscular  (motor)  unrest.  Most 
habitual  smokers  consume  every  day  more  than 
enough  tobacco  to  carry  them  far  beyond  the 
point  where  its  stimulating  effect  ends  and  its 
narcotic  effect  begins.  "Where  this  habitually 
occurs,  the  definitely  toxic  effect  is  notable,  and 
this  results  in  a  demand  for  that  stimulation 
which  the  tobacco  itself  once  furnished,  but  now 
does  not.  Here  is  an  evil  effect  of  tobacco  that 
is  rarely  understood  and  almost  never  admitted. 

OPIUM   AND   CIGAEETTES   IN    CHINA 

Current  history  affords  us  a  striking  proof  of 
the  closeness  of  the  relation  between  tobacco 
and  opium. 


156        HABITS  THAT  HANDICAP 

I  have  spent  a  good  deal  of  time  in  tlie  Orient 
in  the  interest  of  those  who  were  trying  to  sub- 
due the  opium  evil,  and  I  may  add  that  there  is 
in  China  to-day  a  flourishing  American  tobacco 
concern  which  has  grown  rich  out  of  the  sale  of 
cigarettes.  With  the  extremely  cheap  Chinese 
labor,  the  concern  was  able  to  sell  twenty  ciga- 
rettes for  a  cent  of  our  money.  Up  to  the  be- 
ginning of  this  enterprise  (about  1900),  the 
Chinese  had  never  used  tobacco  except  in  pipes, 
and  in  very  minute  quantities  in  rolling  their 
own  crude  cigarettes.  The  concern  was  sending 
salesmen  and  demonstrators  throughout  the 
country  to  show  the  people  how  to  smoke  ciga- 
rettes. Now  it  is  estimated  that  one  half  of  the 
cigarette  consumption  of  the  world  is  in  China. 
In  trying  to  lessen  the  opium  evil,  in  which  they 
have  to  a  considerable  extent  succeeded,  the 
Chinese  are  merly  substituting  the  cigarette  evil. 
It  is  well  known  to  the  confirmed  opium-smoker 
that  he  needs  less  opium  if  he  smokes  cigarettes. 
The  Chinese  to-day  are  spending  twice  as  much 
money  for  tobacco  as  for  opium. 

I  once  said  to  a  Chinese  public  man:  '*I  can 
help  you  to  get  rid  of  the  opium  habit  because 
you  have  found  that  you  must  get  rid  of  it,  but 
I  cannot  help  you  to  get  rid  of  the  evil  you  are 


INJUEIOUSNESS  OF  TOBACCO    157 

substituting  for  it,  for  not  even  America  lias  yet 
found  out  that  she  must  get  rid  of  it.  Your 
cure,  I  fear,  is  worse  than  your  disease ;  and  our 
disease  has  no  cure — until  we  change  our  mental 
attitude. ' ' 

If  any  one  thinks  that  China  is  the  gainer  by 
substituting  the  one  drug  habit  for  the  other,  I 
beg  leave  to  differ  with  him.  The  opium-smoker 
smokes  in  private  with  other  smokers,  and  is 
thus  not  offensive  to  other  people.  He  is  not 
injuring  non-smokers,  or  arousing  the  curiosity 
of  boys,  or  polluting  the  atmosphere,  or  creating 
a  craving  in  others.  In  the  West  the  opium 
habit  is  generally  condemned  because  the  West 
is  able  to  look  with  a  new  and  unbiased  mind  on 
a  drug  habit  that  is  not  its  own. 

I  consider  that  cigarette- smoking  is  the  great- 
est vice  devastating  humanity  to-day,  because  it 
is  doing  more  than  any  other  vice  to  deteriorate 
the  race. 

LIKE   ACTION   OP   THE   THKEE   HABITS 

The  more  you  compare  smoking  and  drinking 
and  drugging,  the  more  resemblances  you  see. 
Opium,  like  tobacco  and  alcohol,  ceases  to  stim- 
ulate the  moment  the  effect  of  it  is  felt :  it  then 
becomes  a  narcotic.    The  history  of  the  three 


158        HABITS  THAT  HANDICAP 

as  a  resort  in  an  emergency  is  precisely  the 
same.  At  the  time  when  the  average  man  feels 
that  he  needs  his  faculties  most,  he  will,  if  ad- 
dicted to  any  of  the  three,  deliberately  seek 
stimulation  from  it.  He  does  not  intend  to  go 
on  long  enough  to  get  the  narcotic  effect,  since 
that  would  be  clearly  defeating  his  own  aims ;  he 
means  to  stop  with  the  stimulant  and  sedative 
effect,  but  that  he  is  unable  to  do.  The  inhaler 
of  tobacco  gets  his  effect  in  precisely  the  same 
way  that  the  opium-smoker  gets  his — the  rapid 
absorption  by  the  tissues  of  the  bronchial  tubes. 
It  may  be  news  to  the  average  man  to  hear  that 
the  man  who  smokes  opium  moderately  suffers 
no  more  physical  deterioration  than  the  man 
who  inhales  tobacco  moderately.  The  excessive 
smoker  of  cigarettes  experiences  the  same  men- 
tal and  physical  disturbance  when  deprived  of 
them  that  the  opium-smoker  experiences  when 
deprived  of  opium.  The  medical  treatment 
necessary  to  bring  about  a  physiological  change 
in  order  to  destroy  the  craving  is  the  same. 
The  effect  of  giving  up  the  habit  is  the  same — 
cessation  of  similar  physical  and  nervous  and 
mental  disturbances,  gain  in  bodily  weight  and 
energy,  and  a  desire  for  physical  exercise.  A 
like  comparison,  item  for  item,  may  be  made 


INJUEIOUSNESS  OF  TOBACCO    159 

with  alcohol,  bnt  it  is  the  similarity  with  opium 
which  I  wish  pai"ticularly  to  emphasize  here. 

TOBACCO  AND   MORAL   SENSITIVENESS 

Morphine,  as  is  very  well  known,  will  distort 
the  moral  sense  of  the  best  person  on  earth ;  it 
is  part  of  the  action  of  the  drug.  Since  the  way 
morphine  gets  its  narcotic  effect  is  very  similar 
to  the  way  tobacco  gets  its  effect,  one  would  nat- 
urally suppose  that  tobacco  would  produce  in  a 
milder  degree  something  of  the  same  moral  dis- 
tortion. This  may  seem  a  startling  conclusion, 
but  change  your  mental  attitude  and  observe. 
Have  not  smokers  undergone  a  noticeable  moral 
deterioration  in  at  least  one  particular?  They 
have  a  callous  indifference  to  the  rights  of 
others.  This  happens  with  all  habitual  indul- 
gence, of  course,  but  is  it  not  carried  more  gen- 
erally to  an  extreme  with  tobacco  than  with  any- 
thing else?  Few  men  quarrel  with  a  hostess 
who  does  not  offer  them  drinks,  but  all  habitual 
smokers  expect  that,  regardless  of  her  own  de- 
sires, she  will  let  them  smoke  after  dinner. 

**We  gave  up  the  fight  against  tobacco  in  our 
drawing-rooms  long  ago,"  said  a  famous  Lon- 
don hostess.  ^'We  found  it  was  a  case  of  no 
smoke,  no  men." 


160         HABITS  THAT  HANDICAP 

Eespectable  men  in  New  York  City  who  would 
not  dream  of  deliberately  breaking  any  other 
law  carry  cigars  and  cigarettes  into  the  subway 
despite  the  fact  that  it  is  forbidden  and  that  it 
is  vitally  necessary  to  keep  the  air  there  as  pure 
as  possible.  A  gentleman  is  more  annoyed  at 
being  forced  to  consult  another's  preference 
about  not  smoking  than  about  anything  else  that 
could  arise  in  social  intercourse,  and  is  often  at 
small  pains  to  conceal  his  impatience  with  old- 
fashioned  people  who  believe  they  have  rights 
which  should  be  respected. 

On  all  sides  the  attitude  seems  to  be,  "What 
right  has  any  one  to  object  to  my  smoMngr' 
The  matter  is  really  on  just  the  opposite  basis, 
*'What  right  has  any  one  to  smoke  when  other 
people  object  to  it?" 

If  a  man  must  get  drunk,  we  say  he  shall  get 
drunk  where  he  is  a  nuisance  only  to  himself 
and  to  others  of  the  same  mind.  If  a  man  feels 
the  need  of  interlarding  his  conversation  with 
obscenity  and  grossness,  we  say  he  may  not  com- 
pel us  to  listen  to  him.  But  a  smoker  may  with 
impunity  pollute  the  air,  offend  the  nostrils,  and 
generally  make  himself  a  nuisance  to  everybody 
in  his  neighborhood  who  does  not  practise  his 
particular  vice.    Is  this  not  a  kind  of  moral 


INJURIOUSNESS  OF  TOBACCO    161 

obtuseness?  Change  your  mental  attitude  and 
consider. 

The  action  of  a  narcotic  produces  a  peculiar 
cunning  and  resource  in  concealment;  it  de- 
velops, when  occasion  arises,  the  desire  to  de- 
ceive and,  whether  occasion  arises  or  not,  the 
desire  to  shift  obligation  and  evade  direct  re- 
sponsibility. Tobacco  does  this  more  mildly 
than  opium,  and  it  does  so  more  appreciably 
with  boys  than  with  men ;  but,  as  with  opium,  it 
is  part  of  the  narcotic  effect  in  all  cases. 

Let  it  always  be  remembered  that  if  a  man 
smokes  and  inhales  tobacco  excessively  he  is 
narcotizing  himself  more  than  when  he  smokes 
opium  moderately. 


CHAPTER  IX 

TOBACCO  AND  THE  FUTURE  OF   THE  EACE 

NEVER  yet  has  tobacco  done  any  good  to  a 
man.  Its  direct  effect  has  been  harmful 
to  millions,  and  indirectly  it  has  harmed  many 
other  millions  by  setting  up  a  systematic  de- 
mand for  stimulants.  Of  all  the  widely  used 
products  of  nature,  tobacco  finds  the  least  ex- 
cuse in  real  necessity.  Virtually  the  only  med- 
ical use  to  which  the  active  principle  of  tobacco 
(nicotine)  can  be  put  is  the  production  of  nau- 
sea, and  there  are  many  other  drugs  that  can 
be  used  with  much  better  effect  for  that  pur- 
pose. If  one  will  study  the  pharmacopoeia,  he 
will  find  that,  next  to  prussic  acid,  nicotine  is 
rated  as  the  most  powerful  known  poison,  and  is 
not  credited  with  a  single  curative  property. 
From  a  medical  point  of  view  it  is  valueless. 

The  social  standing  of  the  man  who  took  it 
from  the  tepees  of  the  North  American  Indians 
to  England  is  mainly  responsible  for  its  taking 
root  there,  for  the  acquisition  of  the  tobacco 

162 


TOBACCO  AND  FUTXIEE  OF  EACE     163 

habit  is  a  painful  process.  Nature's  revolt 
against  it  is  much  more  instinctive  than  her  re- 
volt against  alcohol.  Furthermore,  like  any- 
other  form  of  poison,  its  effects  are  most  im- 
mediate and  evident  upon  the  young  and  weak ; 
for  they  are  easier  to  poison  than  the  mature 
and  strong. 

THE  FCTLL  EFFECT  OF  THE  TOBACCO  HABIT 
IS  NOT  YET  APPARENT 

To  one  who  has  made  a  careful  study  of  the 
effects  of  tobacco  the  prospect  for  the  future  is 
not  encouraging.  The  habit  was  already  wide- 
spread before  the  extensive  manufacture,  or 
even  knowledge,  of  cigarettes  was  introduced 
into  the  United  States,  and  this  later  form  of 
smoking,  which  is  easily  the  most  obnoxious  and 
harmful  of  all,  has  not  yet  had  time  to  disclose 
its  full  power  for  injury.  For  it  is  in  the  in- 
haling of  tobacco  that  the  smoker  receives  his 
greatest  injury,  and  the  habit  of  inhalation  is 
peculiar  to  the  cigarette-smoker.  While  there 
are  smokers  of  cigars  and  pipes  who  inhale  their 
smoke,  it  will  almost  always  be  found  upon  in- 
vestigation that  they  acquired  the  habit  of  in- 
halation through  smoking  cigarettes.  The  aver- 
age man  with  a  cigarette  history  gets  no  pleas- 


164         HABITS  THAT  HANDICAP 

ure  out  of  smoke  wMch  he  does  not  inhale. 
Even  if  a  cigarette  is  made  of  the  best  to- 
bacco, undnigged,  and  wrapped  in  the  purest 
of  rice-paper,  the  mere  fact  that  the  smoke  is 
almost  invariably  inhaled  suffices  to  make  ciga- 
rette-smoking the  most  harmful  form  of  the  to- 
bacco habit.  Inhalation  is  harmful  because  it 
not  only  exposes  the  absorbent  tissues  of  the 
mouth  and  upper  throat  to  the  smoke,  but 
thrusts  the  smoke  throughout  the  throat,  lungs, 
and  nose,  all  of  which  are  lined  with  a  specially 
sensitive  membrane  of  great  absorptive  capac- 
ity. Thus  from  the  smoke  of  the  cigarette  the 
system  takes  up  many  times  as  much  poison  as 
it  takes  up  from  the  uninhaled  smoke  of  the  pipe 
or  cigar.  Indeed,  it  may  be  added  that  the 
purer  and  higher  the  grade  of  the  tobacco,  the 
more  harmful  it  is  to  the  smoker,  for  the  more 
will  it  tempt  him  into  inhalation.  Another 
danger  of  certain  brands  of  cigarettes,  prin- 
cipally the  costly  imported  and  specially 
flavored  brands,  is  that  to  the  extraordinary 
dangers  of  nicotine-poisoning  found  in  all  ciga- 
rettes are  added  in  these  higher  grades  the 
perils  of  their  flavoring  materials,  from  which 
even  so  dangerous  a  drug  as  opium  is  not  always 
absent. 


TOBACCO  AND  FUTITRE  OF  EACE    165 

I  believe  that  the  evil  effects  of  tobacco  will 
be  much  more  apparent  in  the  next  generation 
than  they  are  in  this ;  for  forty  years  ago,  when 
I  was  a  boy,  the  lad  who  decided  to  begin  to 
smoke  knew  nothing  of  cigarettes,  and  had  only 
the  pipe  and  the  cheap  cigar  to  choose  between, 
forms  so  overpowering  that  they  frequently  dis- 
couraged him  at  the  start.  Thus  many  were  un- 
doubtedly saved  from  the  tobacco  habit;  but 
now,  with  mild  cigarettes  upon  the  market,  at 
very  low  prices,  and  in  most  States  found  on 
sale  in  every  candy  store,  the  situation  has  perils 
undreamed  of  at  that  earlier  period.  It  is  note- 
worthy that  cigarettes  are  *' doped"  expressly 
to  allay  nausea,  which  is  the  normal  effect  of 
tobacco-smoking  upon  the  uninured  human  sys- 
tem, and  at  the  same  time  to  quiet  that  motor 
unrest  which  is  the  first  symptom  to  follow  the 
introduction  of  nicotine  into  the  human  system. 
The  narcotic  effect  of  the  adulterant  drugs  is 
therefore  to  ease  the  smoker's  first  pang  and  to 
make  him  more  quickly  the  victim  of  the  tobacco 
habit. 

The  smoker  of  cigarettes  gets  his  narcotic  by 
precisely  the  same  mechanical  process  through 
which  the  opium-smoker  gets  his.  The  opium- 
smoker  would  find  it  far  too  long  and  expensive 


166         HABITS  THAT  HANDICAP 

a  process  to  obtain  the  desired  effect  from  opium 
by  taking  it  into  bis  stomacb;  but  by  burning 
a  very  much  smaller  quantity  of  the  drug  and 
bringing  it  into  contact  with  the  sensitive  ab- 
sorbent tissues  of  the  throat  and  nose,  he  obtains 
the  narcotic  effect  that  his  system  craves. 

THE  USE   OF   TOBACCO   DESTROYS   MORAL 
DISCIPLIISrE 

I  am  convinced  that  the  use  of  cigarettes  is 
responsible  for  the  undoing  of  seventy-five  per 
cent,  of  the  boys  who  go  wrong.  Few  boys  wait 
until  they  are  mature  and  their  resistance  is  at 
its  maximum  before  they  begin  the  use  of  to- 
bacco. It  would  be  remarkable  if  they  did  wait, 
for  their  fathers  and  their  older  brothers  are 
constantly  blowing  smoke  into  their  faces. 
Even  where  restrictive  laws  exist,  minors  find 
no  difficulty  in  obtaining  cigarettes,  so  that  chil- 
dren of  the  age  that  is  most  easily  harmed  by 
the  use  of  tobacco  now  habitually  indulge  in  its 
most  harmful  form. 

There  is  another  unfortunate  effect  of  the  use 
of  tobacco  by  boys.  When  they  begin  to  smoke, 
they  do  so  against  the  wishes  and  usually 
against  the  orders  of  their  parents.  This 
means  broken  discipline  and  deception.    The 


TOBACCO  AND  FUTURE  OF  RACE  167 

boy  who  endeavors  to  conceal  the  fact  that  he 
smokes  is  started  along  a  path  that  is  even  more 
harmful  than  tobacco.  He  has  to  invent  excuses 
for  being  absent  from  home,  and  to  explain  away 
the  odor  of  tobacco  that  is  sure  to  cling  to  him ; 
and  when  a  boy  begins  to  lie  about  these  things, 
he  will  lie  about  others.  So  far  as  truth  goes, 
the  bars  are  down.  Furthermore,  he  has  to 
spend  more  money.  Unless  he  is  one  of  those 
unfortunate  youths  who  are  not  held  to  a  mod- 
erate weekly  allowance,  too  often  he  will  resort 
to  dishonest  means  to  obtain  the  money  to 
satisfy  his  newly  acquired  taste. 

And  that  is  not  all.  Boys  who  spend  their 
time  in  smoking  go  where  they  will  find  other 
lads  also  engaged  in  the  forbidden  habit.  They 
find  congenial  groups  in  pool-rooms,  where  they 
learn  to  gamble,  and  in  the  back  rooms  of 
saloons,  where  they  learn  to  drink.  The  step 
from  the  pool-room  or  the  saloon  to  other  gam- 
bling-places and  to  drinking-places  frequented 
by  the  unworthy  of  both  sexes  is  an  easy  one. 
Thus  the  boy  whose  first  wrong-doing  was  the 
smoking  of  cigarettes  against  the  wishes  of  his 
parents  soon  becomes  the  target  for  all  manner 
of  immoral  influences. 

In  these  days  of  advanced  sociological  study, 


168        HABITS  THAT  HANDICAP 

when  the  mind  of  the  world  is  set  upon  efficiency, 
it  is  astonishing  that  so  little  attention  has  been 
given  to  the  effect  of  tobacco  upon  the  young. 
To  mankind  at  the  present  time  nothing  in  the 
world  is  so  important  as  the  conservation  of  the 
boy.  Humanity  might  well  make  any  sacrifice 
conceivable  in  order  to  keep  its  boys  clean. 
Keeping  boys  clean  means  keeping  girls  clean, 
and  whatever  keeps  boys  and  girls  clean  purifies 
humanity  as  a  whole.  In  other  words,  the  boy 
is  the  most  important  thing  in  the  world,  and 
his  cleanliness  the  most  vital  issue.  Setting 
aside  entirely  the  deleterious  effect  of  nicotine 
upon  his  physical  system,  early  smoking,  which 
usually  means  the  cigarette,  is  the  most  harm- 
ful single  influence  that  is  at  present  working 
against  his  welfare.  We  can  appreciate  the  ter- 
rific total  harm  which  tobacco  does  to  youth,  how- 
ever, only  when  we  add  the  psychological  harm 
and  the  physical  harm  together.  Everything 
considered,  the  question  is  an  appalling  one. 

THE  TEMPTATION   TO  USE  TOBACCO 

It  is  impossible  to  blame  most  boys  very  se- 
verely for  yielding  to  the  smoke-temptation; 
therefore  it  becomes  a  difficult  matter  to  blame 
them  for  the  wrong-doing  which  tends  to  follow 


TOBACCO  AND  FUTURE  OF  RACE  169 

it.  Their  error  is  only  tlie  continuation  of  a 
similar  error  that  their  fathers  have  made  be- 
fore them  and  now  tacitly  encourage.  It  is  diffi- 
cult to  make  any  lad  believe  that  he  need  not  be 
a  fool  because  his  father  is  one.  Yet  in  most 
cases  to  save  a  boy  from  the  demonstrable  ills 
of  tobacco-using  entails  just  this  course  of  rea- 
soning. Orators  and  essayists  from  the  begin- 
ning of  time  have  found  a  stumbling-block  in 
preaching  to  their  followers  virtues  they  admire 
and  value,  but  do  not  themselves  possess.  The 
father  who  forbids  his  son  to  smoke  because  it  is 
harmful  and  expensive,  while  his  own  person 
reeks  with  it,  is  not  likely  to  impress  the  lad 
very  vividly  with  either  the  force  or  the  honesty 
of  his  argument.  More  than  one  parent  has 
found  himself  abashed  in  such  circumstances  by 
a  son  with  logic  and  intelligence.  For  such  a 
parent  there  is  only  one  really  honest  course — • 
to  admit  to  his  son  that  he  himself  has  been  a 
fool,  but  that  he  does  not  wish  his  son  to  follow 
in  his  footsteps. 

THE   NECESSITY  OF  EDIJCATION   CONCEENING 
THE   DANGEB   OF   TOBACCO 

There  is  no  question  in  my  mind  that  this 
jnatter  of  tobacco  should  be  made  the  basis  of 


170        HABITS  THAT  HANDICAP 

a  very  thorough  educational  campaign  among 
the  youth  of  the  United  States.  The  shocking 
spread  of  the  tobacco  habit  among  the  women 
of  American  cities  indicates,  moreover,  need  for 
extending  this  instruction  to  girls  as  well. 

If  cleanliness  of  body  is  next  to  godliness, 
then  cleanliness  of  mind  is  godliness,  and  clean- 
liness of  mind,  real  cleanliness,  is  impossible 
while  ignorance  exists.  Nothing  in  education  is 
more  generally  neglected  than  the  enlightenment 
of  the  young — an  enlightenment  which  can  come 
only  from  the  mouths  of  elders  who  are  them- 
selves clean — as  to  the  deadly  nature  of  alcohol, 
habit-forming  drugs,  and  tobacco.  I  should 
very  much  dislike  to  send  a  young  and  impres- 
sionable son  for  instruction  in  any  subject  to 
any  teacher,  male  or  female,  who  used  ciga- 
rettes. Thousands  upon  thousands  of  parents 
in  this  country  feel  as  I  do  on  this  subject ;  but 
while  they  realize  the  danger  which  might  re- 
sult from  the  influence  of  a  teacher  who  smokes, 
they  utterly  neglect  the  far  more  dangerous  and 
powerful  influence  of  a  father  who  smokes.  To 
my  mind,  however,  it  is  essential  that  parents 
should  seriously  consider  the  personal  character 
of  the  men  to  whom  they  intrust  the  education 
of  their  boys. 


TOBACCO  AND  FUTUEE  OF  EACE  171 

But  the  use  of  tobacco  reaches  far  beyond  the 
home  circle  and  the  schools  and  even  pollutes 
the  atmosphere  of  the  church  itself.  There  are 
few  clergymen  in  the  United  States  who  do  not 
use  tobacco,  and  so  a  clean  father  who  rears  a 
clean  son  is  under  the  tragic  necessity  of  urging 
his  attendance  at  a  dirty  church,  and  later  on 
sending  him  to  be  a  student  in  a  dirty  college, 
for  the  simple  reason  that  there  are  no  clean 
ones. 

Society  seems  to  have  been  viciously  organ- 
ized for  the  destruction  of  the  boy,  in  whom  lies 
its  chief  hope  of  preservation  and  improvement. 
The  boy  who  keeps  clean  does  so  against  tre- 
mendous odds,  to  which  frequently  his  father, 
his  school-teacher,  and  his  clergyman  are  the 
chief  contributors.  A  dozen  times  during  every 
day  of  his  life  he  is  subjected  to  the  third  de- 
gree of  temptation,  and  twice  out  of  three  times 
this  ordeal  is  thrust  upon  him  by  the  very  per- 
sons who  really  should  do  most  to  safeguard 
and  protect  him.  And  now  that  society  has  set 
its  sanction  upon  the  use '  of  tobacco  by  the 
women  of  the  nation,  he  is  confronted  with  the 
further  peril  of  a  mother  who  smokes.  It  seems 
to  me  that  this  tobacco  question  detracts  enor- 
mously from  that  very  vivid  hope  we  might  feel 


172        HABITS  THAT  HANDICAP 

for  the  rising  generation,  which  is  also  handi- 
capped with  alcohol  and  drugs. 

TOBACCO   ADDICTION   MOKE  DANGEROUS  THAN   DEUG 
HABIT  OR  ALCOHOLISM 

I  have  no  desire  to  moralize  npon  the  subject 
of  tobacco.  I  am  not  a  moralist,  but  a  prac- 
tical student  of  cause  and  effect,  urging  the 
elimination  of  bad  causes  so  that  bad  effects 
may  be  eliminated  in  turn.  A  very  wide 
experience  in  studying  the  result  of  the  use 
of  narcotics  has  convinced  me  that  the  total 
harm  done  by  tobacco  is  greater  than  that  done 
by  alcohol  or  drugs.  Nothing  else  at  the 
present  time  is  contributing  so  surely  to  the 
degeneration  of  mankind  as  tobacco,  because, 
while  its  damage  is  less  immediately  acute  than 
that  done  by  alcohol  or  habit-forming  drugs,  it 
is,  aside  from  its  own  evil  effects,  a  tremendous 
contributory  factor  to  the  use  of  both.  There 
is  nothing  to  be  said  in  its  favor  save  that  it 
gives  pleasure,  and  this  argument  has  no  more 
force  in  the  case  of  tobacco  than  in  the  case  of 
opium.  Any  man  who  uses  tobacco  poisons 
himself,  and  the  very  openness  and  permissi- 
bility of  the  vice  serve  to  make  the  process  of 
self -poisoning  dangerous  to  the  public  as  well. 


TOBACCO  AND  FUTURE  OF  RACE  173 

To  sum  up,  the  tobacco  habit  is  useless  and 
harmful  to  the  man  who  yields  to  it ;  it  is  mal- 
odorous and  filthy,  and  therefore  an  infringe- 
ment upon  the  rights  and  comforts  of  others. 
Its  relation  to  alcohol  is  direct  and  intimate. 
When  an  alcoholic  comes  to  me  for  treatment,  I 
do  not  regard  my  chances  of  success  with  him  as 
good  unless  I  can  make  him  see  that  to  abandon 
smoking  is  a  necessary  step  in  his  treatment. 
My  deductions  concerning  the  intimate  relation- 
ship between  the  use  of  tobacco  and  liquors  are 
the  result  of  years  of  observation  and  study. 
And  if  it  is  true  that  no  man  whose  system  is 
alcoholic  is  fit  to  be  the  father  of  a  child,  it  is 
no  less  true  that  the  habitual  smoker  is  also  un- 
worthy to  be  a  guardian  of  his  kind.  The  alco- 
holic fiend  almost  invariably  becomes  the  parent 
of  children  provided  with  defective  nervous  sys- 
tems, of  children  as  definitely  deformed  nerv- 
ously as  they  would  be  physically  if  born  with 
club-feet  or  hare-lips. 


CHAPTER  X 

THE  SANATORIUM 

THERE  is  no  class  of  patients  in  the  world 
to  whom  the  physician,  and  especially  the 
physician  who  conducts  a  sanatorium,  can  offer 
so  good  an  excuse  for  long-continued  treatment 
as  to  those  addicted  to  the  use  of  drugs.  It  is 
certain  that  the  person  who  makes  a  weekly 
charge  to  such  patients  is  rarely  honest  with 
them  or  tries  to  shorten  their  stay.  Several 
years  ago  I  freely  and  without  reservation  gave 
all  the  details  of  my  treatment  to  the  medical 
world,  and  though  many  institutions  have  en- 
deavored to  install  it  as  a  part  of  their  own  cura- 
tive policy,  most  have  failed.  The  failure  may 
he  attributed  principally,  if  not  wholly,  to  the 
fact  that  few  have  also  adopted  the  necessary 
principle  of  a  fixed  charge,  without  regard  to  the 
length  of  time  the  patient  is  under  treatment. 
The  weekly  charge,  with  its  attendant  tempta- 
tion to  keep  the  patient  as  long  as  possible,  has 
invariably  defeated  all  possibilities  of  success. 

174 


THE  SANATORIUM  175 

There  is  also  a  class  of  institutions  in  wliicli 
the  ''cure''  for  the  drug  habit  consists  in  the 
administration  of  the  drug  itself  in  a  disguised 
form.  In  such  surroundings  a  patient  will  con- 
tentedly stay  indefinitely,  for  the  chains  of  his 
habit  bind  him  to  the  spot.  The  very  fact  that 
he  wishes  to  stay  may  be  accepted  as  a  proof 
that  he  has  not  been  benefited  by  it.  For  the 
man  who  has  been  freed  from  a  drug  habit  de- 
sires a  normal  life  in  the  world;  indeed,  only 
his  reentrance  into  its  turmoil  and  bustle  can 
set  him  surely  on  his  feet. 

The  average  sanatorium,  accustomed  to  the 
time-honored  and  thoroughly  established  sys- 
tem of  making  its  patients  comfortable, — in 
other  words,  pampering  and  coddling  them, — • 
finds  it  difficult,  if  not  impossible,  to  conform  in 
every  detail  to  the  necessities  of  a  system  like 
mine. 

Even  if  the  institution  is  equipped  with  every 
possible  facility,  it  is  highly  probable  that  the 
physicians  in  charge  may  be  mentally  unfitted 
to  the  work.  Inured  by  every  detail  of  their 
training  to  methods  that  make  a  successful 
treatment  of  drugs  impossible,  they  find  them- 
selves incapable  of  changing  when  confronted 
by  specific  cases  that  demand  a  radically  differ- 


176        HABITS  THAT  HANDICAP 

ent  treatment.  The  institutions  themselves  are 
equally  inadaptable.  The  sanatorium,  it  must 
be  remembered,  is  really  a  boarding-house  or 
hotel,  and  the  business  of  boarding-house  or 
hotel,  whether  it  presents  an  epicurean  or  * '  sani- 
tary" bill  of  fare,  or  whether  its  staff  is  supple- 
mented by  trained  nurses  and  physicians  or  not, 
remains  a  boarding-house  or  hotel.  Its  main 
province  is  to  keep  its  paying  guests  and  to 
make  them  comfortable. 

The  whole  sanatorium  situation  so  far  as  it 
relates  to  the '  *  cure"  of  those  addicted  to  the  use 
of  drugs  and  alcohol  may  be  summed  up  in  a 
few  words.  The  average  sanatorium  is  merely 
a  small  colony  of  drug-users.  No  one  can  deny 
that.  Now,  no  man  who  has  been  freed  from 
his  desire  for  drugs  and  iio  one  who  is  being 
made  uncomfortable  by  deprivation  will  remain 
in  such  surroundings  for  any  length  of  time. 
The  natural  conclusion  is  that  such  institutions 
are  not  accomplishing  what  they  have  promised 
to  be  able  to  accomplish.  The  inmates  are  still 
drug-users.  This  is  not  true  of  American  insti- 
tutions alone.  Within  a  few  months  I  have  had 
as  an  eleven-day  inmate  of  my  own  institution 
a  very  wealthy  man  who  has  made  three  Euro- 
pean journeys  to  find  relief  from  the  drug  habit, 


THE  SANATORIUM  177 

on  eacli  journey  going  the  rounds  of  six  or  eight 
celebrated  institutions,  and  taking  the  treatment 
of  each  without  result.  Successful  treatment  is 
brief  treatment,  and  no  establishment  operating 
upon  a  system  of  a  weekly  charge  to  patients 
will  make  an  earnest  effort  to  release  these  pa- 
tients as  soon  as  possible.  In  their  desire  to 
make  their  patients  comfortable,  and  so  prolong 
their  stay,  their  usual  quantity  of  drugs  is  sup- 
plied to  them,  though  of  course  in  some  dis- 
guised form.  There  is  no  other  way  of  accom- 
plishing this. 

Moreover,  so  long  as  a  patient  is  thus  kept 
comfortable,  he  is  unable  to  describe  his  symp- 
toms, for  he  does  not  feel  them.  The  drug, 
therefore,  hides  exactly  those  details  of  a  man's 
condition  that  it  is  essential  for  the  attending 
physician  to  know.  In  a  normal  man  the  pres- 
ence of  pain  is  always  a  guide  for  a  physician, 
but  in  a  drugged  ease  this  is  always  absent. 
The  constant  drugging  that  conceals  the  symp- 
toms of  organic  ailment  may  permit  one  of  com- 
parative insignificance  at  the  time  a  patient  en- 
tered a  sanatorium  to  become  incurable  before 
he  leaves.  Thus  the  result  of  his  stay  may 
mean  in  the  end  a  serious  or  even  fatal  deteri- 
oration. 


178        HABITS  THAT  HANDICAP 

And  tlie  prolonged  stay  becomes  a  means,  in- 
tentional or  unintentional,  of  mulcting  the  pa- 
tient or  Ms  friends  of  money.  The  sum  an- 
nually spent  in  the  United  States  upon  useless 
sanatorium  treatment  must  certainly  amount  to 
millions.  I  have  had  patients  come  to  me  from 
such  institutions  to  which  they  had  paid  sums 
as  large  as  $10,000.  Wealthy  people  are  spe- 
cially likely  to  become  victims  of  this  form  of 
rapacity,  and  a  mere  glance  at  some  of  the  re- 
ceipted bills  that  I  have  seen  in  their  possession 
is  enough  to  stagger  a  modest  financial  imagina- 
tion. The  ingenuity  with  which  a  sanatorium 
manager  devises  "extras"  is  worthy  of  the 
name  of  genius.  And  the  physically  incurable 
patient  is  often  retained  in  the  sanatorium  till 
his  money  or  the  money  of  his  friends  is  ex- 
hausted in  a  needless  sacrifice  to  greed. 

THE  physician's  ATTITUDE  TOWAED  THE  DRITG-USEB 

It  is  also  necessary  to  direct  attention  to  some 
of  the  errors  of  the  general  medical  practitioner 
who  deals  with  cases  of  this  sort.  It  is  not  un- 
natural for  a  doctor  to  hesitate  at  the  thought 
of  surrendering  his  patient  into  strange  hands. 
There  may  be  unselfish  as  well  as  purely  mer- 
cenary reasons  for  this  hesitation.    The  doctor 


THE  sanatorium:  179 

may  liope  that  he  himself  can  aid  the  sufferer, 
and  may  therefore  endeavor  to  administer  this 
treatment  either  in  the  patient's  home  or  possi- 
bly in  his  own  residence  or  private  hospital. 
The  patient  is  likely  to  be  as  much  inclined  to 
this  course  as  the  doctor,  for  the  doctor  is  his 
friend  and  confidant,  and  he  dislikes  intensely 
the  idea  of  revealing  what  he  regards  as  the 
shameful  secret  of  his  enslaved  soul  to  stran- 
gers* ears.  Treatment  in  the  doctor's  or  the 
patient's  own  environment  must  of  necessity  be 
an  expensive  matter,  but  if  the  patient  can 
afford  it,  he  is  likely  to  desire  it.  This  is  most 
natural,  especially  if  the  patient  is  one  of  the 
tens  of  thousands  who  have  tried  the  treatment 
offered  by  a  sanatorium  and  found  it  not  only 
valueless,  but  horrifying.  There  are,  too,  many 
patients  who  from  sheer  lack  of  funds  naturally 
desire  a  home  administration  of  the  treatment 
as  a  means  of  saving  expense.  Of  course  many 
of  the  most  worthy  cases  are  to  be  found  among 
people  of  moderate  or  small  means.  The  drug 
habit  is  itself  impoverishing. 

Even  so  I  find  myself  irresistibly  impelled  to 
advise  against  any  attempt  to  treat  such  cases 
in  their  own  environment,  or  in  any  environ- 
ment improvised  by  a  local  doctor.    This  I  do 


180        HABITS  3:HAT  HANDICAP 

only  because  I  have  known  so  many  cases  of 
utter  failure,  so  many  cases  where  the  suf- 
ferer's final  hope  has  been  destroyed  by  such 
experiments. 

PEIVATE  ADMINISTEATIOIT  OF  TREATMENT  NOT 

SUCCESSFUIi 

The  friendship  existing  between  a  physician 
and  his  patient  must  often  disarm  the  former 
and  incapacitate  him  for  the  strict  dealing  that 
is  required  in  a  treatment  like  mine.  The  mere 
fact  that  in  caring  for  a  friend  or  one  of  his  reg- 
ular patients  the  doctor  feels  unwilling  to  exact 
a  definite  charge  in  advance  is  a  certain  handi- 
cap here,  as  is  also  the  fact  that  each  patient 
needs  continual  watching,  and  no  doctor  can  af- 
ford to  devote  his  entire  time  and  constant  med- 
ical attention  to  one  patient.  The  average  doc- 
tor in  private  practice,  moreover,  finds  it  impos- 
sible to  secure  upon  demand  nurses  of  sufficient 
moral  responsibility  and  medical  assistants  of 
sufficient  technical  training  to  cooperate  with 
him  in  the  work.  Above  all,  I  find  that  only 
when  the  patient  is  on  premises  other  than  his 
own,  in  unfamiliar  surroundings  where  he  is 
subject  to  a  strict  and  inviolable  discipline,  can 
the  best  results  be  obtained.    The  doctor  who 


THE  SANATORIUM  181 

administers  tMs  treatment,  if  lie  is  to  win,  must 
have  every  advantage.  Hospital  surroundings, 
unfamiliar  nurses,  and  strange  assistant  doc- 
tors are  of  great  value ;  but  payment  in  advance 
may  be  regarded  as  the  most  etfective  means 
for  inducing  the  patient  to  complete  the  neces- 
sary course.  An  amazing  number  of  people 
have  come  to  me  who  have  confessed  that  while 
they  have  from  time  to  time  tried  other  treat- 
ments, they  have  never  completed  one  of  them. 
Others  come  in  a  skeptical  frame  of  mind.  I 
can  mention  one  such  who  had  been  three  times 
to  Europe,  each  time  on  the  advice  of  the  very 
doctor  who,  as  the  patient  was  aware,  had  been 
responsible  for  his  forming  the  habit. 

No  physician  in  private  practice  should  ever 
attempt  to  relieve  a  patient  from  a  drug  habit 
in  a  manner  incidental  to  the  conduct  of  his 
practice,  though  it  is  nevertheless  true  that  the 
temptation  for  doctors  to  attempt  this  are  ex- 
traordinary. A  patient  who  becomes  aware 
that  his  physician  knows  of  a  treatment  which 
will  bring  relief  is  likely  to  bring  to  bear  upon 
the  physician  every  possible  pressure  in  the 
effort  to  induce  him  to  administer  it.  The  doc- 
tor must  be  liberal  indeed  who,  having  made 
such  an  attempt  and  failed  to  achieve  good  r^- 


182         HABITS  THAT  HANDICAP 

suits  with  it,  will  acknowledge  tliat  he  was  mis- 
taken at  the  start. 

THE  NECESSITY  OF  A  FIXED  CHARGE  FOE  TREATMENT 

The  advantage  of  a  definite  charge,  paid  in 
advance,  was  a  discovery  that  I  made  early  in 
my  work.  "With  a  large  proportion  of  my  pa- 
tients it  would  otherwise  have  been  impossible 
for  me  to  obtain  the  definite  medical  result 
which  has  characterized  my  work. 

It  is  quite  impossible  to  make  an  intelli- 
gently satisfactory  mental  or  physical  diagnosis 
of  any  patient  brought  to  me  until  he  has  been 
entirely  freed  from  the  drug  which  he  has  been 
taking.  As  soon  as  this  has  been  fully  accom- 
plished, it  is  possible  to  consider  the  case  care- 
fully. It  is  also  necessary  to  make  an  invari- 
able rule  that  no  person  entering  my  institution 
for  treatment  shall  be  permitted  to  come  into 
contact  with  any  other  person  who  is  there  for 
treatment,  for  there  can  be  nothing  psychologi- 
cally worse  than  the  discussion  of  symptoms  and 
the  exchange  of  experiences  among  people  un- 
der treatment.  It  is  also  a  rule  that  in  the  in- 
stitution physicians  employed  in  the  establish- 
ment shall  not  become  intimate  with  the  patients 
or  spend  with  them  any  time  not  necessarily  de- 


THE  SANATORIUM  183 

voted  to  professional  investigation  and  attend- 
ance. 

Nurses  also  must  be  as  businesslike  as  pos- 
sible in  all  their  relationships  with  patients,  and 
must  do  as  little  hand-holding  and  sympathiz- 
ing as  possible  even  in  the  cases  of  ultra-nerv- 
ous women  patients.  It  is  a  principle  of  the 
average  sanatorium  to  encourage  the  "sympa- 
thetic" nurse.  Wittingly  or  unwittingly,  the 
old-time  sanatorium  made  a  practice  of  manu- 
facturing habitual  sanatorium  inmates.  The 
most  hopeless  cases  I  have  ever  seen  have  been 
those  who  have  become  inured  to  wearing  sana- 
torium stripes.  Such  will  never  change  their 
tailor  till  their  pocket-book  becomes  empty. 

Another  detail  of  my  treatment  not  easily 
compassed  in  the  average  sanatorium  is  to  con- 
sider every  case  as  an  individual  case,  to  be 
dealt  with  individually.  In  private  practice 
this  is  often  overlooked,  and  to  this  I  also  attri- 
bute many  failures  in  treatment.  The  individu- 
ality of  every  ease  must  be  borne  in  mind  not 
only  throughout  the  treatment  itself,  but  after- 
ward, during  the  period  of  recuperation.  The 
case  itself  is  sure  to  indicate  in  some  measure 
the  further  treatment  which  should  be  followed 
in  the  period  immediately  succeeding  the  pa- 


184        HABITS  THAT  HANDICAP 

tient's  discharge  from  my  institution,  and  very 
frequently  indicates,  in  fact,  the  necessity  for 
consultation  with  other  specialists  and  for  a 
surgical  operation.  After  the  patient  has  heen 
relieved  of  drugs  comes  the  time  to  begin  the 
necessary  physical  upbuilding  by  means  of  ex- 
ercise. Although  I  may  have  seemed  to  con- 
demn the  sanatorium,  I  must  add  now  that  some 
institutions  are  specially  qualified  to  assist  in 
this  building-up  process.  Some  health-building 
institutions  that  devote  their  entire  attention  to 
strengthening  their  patients  by  means  of  phys- 
ical exercise  are  doing  wonderfully  good  work. 
The  fact  that  my  methods  in  treating  these 
cases  have  prevented  me,  and  will  prevent  me, 
from  becoming  directly  or  indirectly  interested 
in  any  institution  other  than  my  own,  in  New 
York  City,  gives  me  a  freedom  in  offering  ad- 
vice to  patients  concerning  what  they  should  do 
after  they  have  left  my  care  that  I  should  not 
feel  if  my  institution  were  operated  upon  the 
old-time  keep-them-as-long-as-you-can  plan.  I 
find  it  possible  to  suggest  physical  exercise  and 
even  professional  training  to  those  who  espe- 
cially need  it  with  entire  disinterestedness,  just 
as  I  find  it  possible  to  suggest  to  some  an  in- 
vestigation of  some  religious  influence. 


THE  SANATORIUM  185 

It  must  be  laid  down  as  an  axiom  that  the  pa- 
tient must  have  a  mental  as  well  as  a  physical 
change  before  the  treatment  can  accomplish  all 
the  good  of  which  it  is  capable.  Such  a  mental 
change  is  highly  improbable  in  the  comfortable 
surroundings  of  the  average  sanatorium.  No 
man  or  woman  ever  achieved  it  by  sitting  on  a 
pleasant  veranda  in  an  easy-chair  exchanging 
tales  of  symptoms  with  other  invalids. 

THE   BEASON   FOE   THE   FIXED   CHARGE 

The  principal  consideration  which  has  influ- 
enced me  in  shaping  my  policy  of  a  definite 
charge  and  limiting  the  length  of  stay  of  my  pa- 
tients has  been  the  fact  that  I  find  it  impossible 
when  the  effect  of  the  drug  has  been  perfectly 
eliminated  to  hold  most  of  the  patients  under 
restraint.  The  man  who  has  won  freedom  from 
his  habit  feels  sure  of  himself ;  he  desires  to  get 
away,  and  he  is  not  afraid  to  go  out  into  the 
world,  where  it  may  be  possible  for  him  to  get 
the  drug  again.  He  will  not  yield  to  the  temp- 
tation to  get  it,  partly  because  he  will  not  want 
it,  and  partly  because  he  knows  the  horror  of 
the  habit  and  does  not  wish  to  become  involved 
in  it  again.  As  a  matter  of  fact,  one  of 
the  hardest  tasks  I  have  is  that  of  inducing 


186         HABITS  THAT  HANDICAP 

people  to  stay  as  long  with  us  as  we  think  neces- 
sary, although  their  prolonged  stay  means  no 
additional  payment  to  us  and  no  additional  ex- 
pense to  them. 

That  is  one  of  the  principal  arguments 
against  colonization ;  and  it  is  as  much  an  argu- 
ment against  the  average  municipal  or  state  in- 
stitution as  it  is  against  the  average  sanatorium. 
The  theory  of  colonization  in  this  matter  is  all 
wrong. 

The  question  of  a  definite  charge  has  as  much 
influence  on  my  own  attitude  as  on  that  of  the 
patient.  From  the  fact  that  I  know  when  a  pa- 
tient enters  my  house  that  I  can  get  no  further 
money  from  him  or  her  beyond  the  advance  pay- 
ment I  gain  a  distinct  advantage.  I  do  not  feel 
it  necessary  to  cater  to  my  patient's  whims,  nor 
do  I  feel  it  necessary  to  sacrifice  any  portion  of 
the  necessary  routine  of  the  treatment  because 
the  patient  may  be  rich  or  influential  and  may 
make  extraordinary  demands  upon  me.  All 
that  I  have  to  do  is  to  go  ahead  along  those  lines 
which  I  know  are  effective  and  which  will  gain 
results. 

The  effect  of  this  system  is  equally  admirable 
upon  the  members  of  my  medical  staff,  for  our 
efforts  are  devoted  not  to  keeping  the  patient 


THE  SANATORIUM  187 

as  long  as  possible  for  the  purpose  of  increas- 
ing revenue  but  to  getting  rid  of  Mm  as  quickly 
as  possible,  so  tliat  tbe  profit  will  be  relatively 
large.  That  it  is  to  his  advantage  as  well  as 
to  mine  to  see  that  the  treatment  is  complete 
and  effective  before  the  patient  leaves  is  obvi- 
ous. 

These  methods  take  into  consideration  my 
own  and  my  patient  ^s  psychology.  A  man  who 
deals  with  this  type  of  patient  needs  every  ad- 
vantage which  he  can  get,  for  invariably  he  is 
dealing  with  abnormalities. 

PHYSICAL   DEFECTS   REVEALED   BY   TEEATMENT 

The  treatment  itself  is  certain  to  uncover 
these  abnormalities,  revealing  whether  or  not 
they  are  due  to  physical  causes.  It  becomes 
very  quickly  evident  if  there  is  any  real  physical 
reason  why  a  patient  is  not  eligible  for  treat- 
ment, as  in  the  case  of  an  incurable  and  painful 
physical  ailment.  No  matter  how  careful  and 
frank  a  patient's  statements  may  be  or  how 
elaborate  the  diagnosis  that  his  physician  has 
transmitted  to  me,  no  matter  how  elaborately 
careful  are  the  preliminary  examinations  made 
by  my  own  physician,  it  is  not  until  the  drug  has 
been  entirely  eliminated  that  we  find  it  possible 


188        HABITS  THAT  HANDICAP 

to  make  a  really  intelligent  diagnosis.  The 
symptoms  of  disease,  however,  are  sure  to  ap- 
pear before  the  first  part  of  the  treatment  is 
completed.  It  is  a  standard  policy  of  my  hos- 
pital at  once  to  inform  a  patient  who  has  proved 
to  be  physically  ineligible,  and  to  return  to  him 
his  fee. 

This  method  of  procedure  has  made  us  care- 
ful before  accepting  patients  to  study  their  his- 
tories, for,  naturally,  we  do  not  wish  to  do  even 
preliminary  work  and  then  return  the  fee  in  full. 
We  accept  no  patient  for  treatment  until  we  are 
provided  with  a  careful  and  detailed  history  of 
his  case,  and  it  is  upon  a  large  collection  of  such 
histories  that  I  have  based  many  of  the  theories 
embodied  in  the  subject  matter  of  this  book. 
It  is  especially  these  detailed  histories  which 
have  enabled  me  to  fix  with  some  accuracy  of 
judgment  the  circumstances  leading  up  to  the 
formation  of  most  drug  habits.  In  our  invari- 
able practice  of  returning  the  fee  and  discharg- 
ing the  patient  whom  we  find  ineligible  for 
treatment  we  have  surely  taken  a  step  in  ad- 
vance. There  is  scarcely  an  institution  of  this 
sort  in  the  United  States  to  which  a  patient 
might  write,  **I  am  taking  drugs,"  without  re- 
ceiving in  reply  the  invitation,  "Come  to  us. 


THE  SANATOEIUM  189 

and  we  will  treat  you, ' '  implying  that  they  will 
give  the  treatment  whether  or  not  an  examina- 
tion of  the  patient  shows  that  he  is  one  who  can 
benefit  from  it. 

THE  DUTY   OF  THE   MEDICAL  PROFESSION 

The  victim  of  drugs,  whether  he  is  rich  or 
poor,  old  or  young,  good  or  bad,  deserves  the 
public  sympathy  in  a  measure  scarcely  equaled 
by  any  other  class.  These  folk  are  sick  folk  in 
every  way  I  can  possibly  think  of.  I  am  at- 
tempting to  see  to  it  that  they  are  protected  by 
every  safeguard  from  being  victimized.  It  is 
my  hope  that  through  continual  and  untiring 
education  I  may  force  the  state  medical  institu- 
tions throughout  the  country  to  assume  their 
rightful  responsibility  in  providing  proper  care 
for  drug  victims  who  have  slight  means  or  none. 
I  purpose  to  work  toward  the  awakening  of  the 
medical  profession  to  its  responsibility  not  only 
in  regard  to  the  growth  of  new  crops  of  drug- 
users,  but  to  the  care  and  relief  or  sequestration 
from  medical  practice  of  those  among  its  own 
members  whose  condition  warrants  action. 

Perhaps  this  last  step  should  be  the  first  one 
to  be  taken.  I  have  given  it  much  thought,  and 
can  see  only  one  way  out  of  the  veritably  in- 


190        HABITS  THAT  HANDICAP, 

fernal  tangle  in  which  the  medical  profession 
has  enmeshed  itself.  That  would  involve  a  con- 
ference between  delegates  from  the  medical  so- 
cieties of  the  various  States  to  form  a  plan 
whereby  the  medical  profession  as  a  whole  or 
in  groups  might  establish  and  support  an  in- 
stitution or  a  number  of  institutions.  These 
should  be  backed  by  the  most  eminent  and  con- 
scientious men  in  the  profession.  They  should 
be  managed  by  men  fully  competent,  and  should 
be  open  not  only  to  physicians  who  need  treat- 
ment and  are  unable  to  pay  for  it  at  a  private 
institution,  but  to  all^atients,  in  the  certainty 
that  there  they  will  receive  the  proper  treat- 
ment, properly  administered,  and  at  a  reason- 
able charge.  I  purpose  furthermore  that  every 
institution  under  private  management  in  the 
United  States  shall  by  law  be  held  responsible 
for  its  methods  of  treatment. 

LEGISLATION  TO   EEGULATE   SAFATOEIUMS 

There  should  be  the  most  drastic  legislation 
compelling  all  physicians  and  institutions  ac- 
cepting this  class  of  patients  for  treatment  to 
report  periodically  to  the  board  of  health  which 
has  jurisdiction  in  their  district  whenever, 
after  a  three  weeks'  medical  supervision,  they 


THE  SANATOBIUM  191 

still  require  the  administration  of  habit-forming 
drugs.  It  is  only  reasonable  that  any  institu- 
tion accepting  a  patient  for  this  treatment,  and 
failing  to  secure  favorable  results  within  a 
period  of  twenty-one  days,  should  report  the 
case  to  the  authorities,  giving  detailed  reasons 
for  the  failure  of  the  patient  to  respond  to  treat- 
ment. 

The  general  adoption  of  this  rule  of  pro- 
cedure would  mean  that  a  class  of  unfortunates 
who  have  never  had  any  protection  from  any 
source  would  be  immediately  provided  with  defi- 
nite medical  help.  An  accompanying  provision 
would  insist  that  patients  who  for  physical 
reasons  are  found  to  be  ineligible  for  treatment 
— unable,  that  is,  to  exist  in  comfort  without 
regular  doses  of  their  drug — ^will  be  relieved  of 
all  sense  of  disgrace  arising  from  this  necessity, 
and  will  be  preserved  from  victimization,  and 
will  find  it  possible  to  get  the  drug  without  diffi- 
culty and  at  reasonable  prices,  if  necessary, 
from  the  boards  of  health  themselves.  If  this 
plan  accomplished  nothing  more  than  to  pre- 
vent the  operation  of  medical  fraud  against  suf- 
ferers for  a  period  longer  than  three  weeks,  it 
would  even  then  have  accomplished  an  extraor- 
dinary good. 


192        HABITS  THAT  HANDICAP 

I  have  in  my  present  hospital  only  fifty  beds, 
a-nd  as  a  rule  I  receive  and  discharge  about  four 
patients  a  day.  Were  my  institution  operated 
along  the  colonization  lines  which  are  common 
in  the  United  States,  the  volume  of  business 
which  I  handle  in  a  year,  running  well  above  a 
thousand  patients,  would  require  not  fifty,  but  at 
least  five  hundred  beds,  and  rooms  in  propor- 
tion. This  statement  of  the  exact  situation  in 
my  own  institution  may  possibly  explain  exist- 
ing conditions  in  some  others. 

It  must  not  be  understood  that  I  attribute  all 
the  efforts  at  colonizing  drug-users  to  un- 
worthy motives.  Much  of  it  has  been  due  to  the 
complete  ignorance  of  the  medical  profession 
in  regard  to  this  form  of  affliction.  Finding  it- 
self unable  intelligently  to  cope  with  conditions, 
it  seeks  the  line  of  least  resistance  and  adopts 
the  colonizing  sanatorium,  with  all  its  evils,  ag 
the  best  plan  that  can  be  found.  When  I  first 
took  up  this  work  I  went  for  information  and 
assistance  not  to  the  humble  members  of  the 
medical  profession,  but  to  the  most  eminent  men 
whom  I  could  find.  Even  these  men  invariably 
admitted  their  ignorance  of  the  nature  of  the 
drug  habit  and  the  means  for  its  relief.  I  was 
told  by  some  of  the  best-known  neurologists  in 


THE  SANATORIUM  193 

the  world  that  out  of  thousands  of  patients 
whom  they  and  their  confreres  had  sent  to  the 
best-known  and  most  conscientiously  operated 
institutions  in  the  country  not  one  had  really 
been  helped.  They  assured  me  that  if  I  had 
found  something  which  would  give  actual  and 
material  aid  in  any  degree  to  even  five  per  cent, 
of  the  drug  victims  who  were  sent  to  me  for 
treatment,  I  would  be  doing  more  than  any  man 
had  ever  done  before. 


CHAPTER  XI 

PREVENTIVE   MEASURES   FOR   THE   DRUG  EVIL 

EARLY  in  my  investigations  into  tlie  proper 
facilities  for  the  medical  treatment  of 
drug-users  it  became  apparent  that  this  oould 
not  be  properly  carried  out  in  the  patient's  own 
environment,  in  a  general  hospital  where  new 
facilities  had  not  been  introduced,  or  in  the 
usual  sanatorium.  It  became  necessary  for  me 
then  to  outline  some  system  by  which  the  med- 
ical profession  might  properly  take  up  the  work 
and  to  suggest  some  basis  on  which  the  medical 
men  of  various  States  might  combine  in  an  ef- 
fort to  remove  the  treatment  of  these  sufferer^ 
from  the  hands  of  the  irresponsible. 

Some,  if  not  the  majority,  of  the  worthiest 
subjects  of  the  drug  habit  are  people  who  can- 
not pay  large  sums  or  travel  long  distances  in 
their  search  for  relief.  It  seemed  clear,  there- 
fore, that  state  institutions  should  be  equipped 
with  facilities  and  knowledge  for  dealing  with 
this  afi^ction. 

194 


PEEVENTIVB  MEASURES         195 

THE  NEED  FOE  PKACTICAL  INSTRUCTION 

At  the  present  time  there  is  in  existence  no 
clinic  or  other  practical  place  of  demonstration 
where  a  doctor  can  get  competent  instruction  in 
this  important  branch  of  medical  work.  I  hope 
the  time  will  come  when  it  may  be  possible  for 
me  to  offer  to  the  medical  profession  a  clinic 
where  the  professional  student  may  prepare  for 
this  line  of  effort  as  effectively  as  he  may  now 
prepare  himself  for  any  special  work,  like  nose 
and  throat  diseases.  This  can  come  about  only 
through  some  arrangement  in  which  I  have  no 
financial  interest. 

SKEPTICISM   OF   THE   MEDICAL  PROFESSION 

I  am  fully  aware  that  I  must  first  overcome  a 
strong  undercurrent  of  skepticism  among  the 
members  of  the  medical  profession.  The  effi- 
cacy of  the  treatment  must  be  proved.  Even 
among  the  best-informed  physicians  it  is  a  pop- 
ular belief  that  the  treatment  which  I  announce 
as  simple  is  really  an  impossibility.  No  matter 
what  the  doctor  has  hoped  that  he  might  do,  he 
has  been  told  by  text-books  and  articles  in  med- 
ical periodicals  that  it  cannot  be  done.  This 
fallacious  teaching  must  be  counteracted  before 


196         HABITS  THAT  HANDICAP 

much  can  be  accomplished,  and  in  the  progress 
of  the  work  many  traditions  of  the  profession 
must  be  violated.  Before  he  can  hope  to  ac- 
complish anything  of  importance  in  the  admin- 
istration of  my  method  of  treatment,  the  physi- 
cian must  understand  that  the  length  of  time  a 
drug-user  has  been  taking  the  drug,  the  quantity 
that  he  has  taken,  and  the  manner  of  its  admin- 
istration are  matters  of  no  consequence.  Short 
histories  and  small  amounts,  long  histories  and 
large  amounts,  are  all  one  when  it  comes  to 
the  administration  of  this  treatment.  I  went  to 
Dr.  Eichard  C.  Cabot  of  Boston  with  a  letter  of 
introduction  from  Dr.  Alexander  Lambert  of 
New  York,  whom  he  knew  well  and  admired. 
He  listened  to  my  statement  of  the  facts  which 
I  have  just  set  forth. 

'*I  have  heard  what  you  say,  but  I  shall  not 
believe  it  until  it  has  been  demonstrated  to  me," 
he  declared. 

I  demonstrated  it,  and  convinced  him.  A 
similar  skepticism  remains  general  throughout 
the  medical  profession. 

The  experience  that  the  medical  profession 
has  already  had  in  New  York  State  as  the  result 
of  prohibitive  legislation  indicates  the  many 
problems  that  arise  immediately  after  the  drug 


PREVENTIVE  MEASURES         197 

is  put  beyond  the  reach  of  those  who  have  ac- 
quired the  habit.  It  is  only  natural  that  the  un- 
scrupulous should  seek  to  take  advantage  of  the 
opportunities  created  by  this  situation.  "With- 
out proper  treatment,  an  habitual  drug-user 
cannot  endure  the  agony  of  deprivation  until  a 
definite  physiological  change  has  occurred;  so 
that  unless  the  medical  profession  is  informed 
of  this  fact,  and  the  community  at  large  is  pro- 
vided with  facilities  for  the  administration  of 
the  required  treatment,  it  is  almost  inevitable 
that  restrictive  measures  wiU  be  followed  imme- 
diately by  the  victimization  of  the  unfortunate 
by  the  unscrupulous.  One  detail  of  the  peril  to 
society  which  may  accrue  from  a  general  cessa- 
tion of  the  drug  traffic  without  the  provision  of 
proper  facilities  for  the  care  of  those  who  have 
been  its  victims  is  that  those  who  are  accus- 
tomed to  drugs,  on  being  suddenly  deprived  of 
them,  almost  invariably  turn  to  alcohol  for 
stimulation  and,  without  being  the  least  re- 
lieved of  the  drug  habit,  with  abnormal  speed 
become  alcoholics.  Modern  society  presents  few 
spectacles  of  suffering  more  acute  than  that  en- 
dured by  the  drunken  drug-fiend.  Few  per- 
sons, moreover,  are  so  dangerous  to  its  wel- 
fare. 


198        HABITS  THAT  HANDICAP 

MEDICAL  ETHICS 

Constantly  I  must  lay  emphasis  upon  the  re- 
sponsibility of  the  physician  in  regard  to  drug 
habits.  This  phase  of  the  subject  must  be  an 
ever-recurring  one,  because  the  whole  unpleas- 
ant situation  has  grown  out  of  medical  igno- 
rance. While  treatment  for  drug-users  is  at 
last  making  headway,  for  a  long  time  experi- 
mentation had  no  chance  save  with  a  small  num- 
ber of  broad-minded  and  bright-minded  doctors 
who  were  able  to  shake  off  the  shackles  that  held 
the  less  intelligent  members  of  their  profession. 

"When  I  made  public  the  formulas  of  my  treat- 
ment, I  did  not  understand  this  phase  of  medical 
ethics.  I  assumed  that  certain  dangers  might 
arise  from  the  probable  activities  of  the  omni- 
present medical  faker,  who  without  any  genuine 
effort  to  administer  my  treatment  properly 
would  advertise  it  widely,  and  thus  victimize  the 
innocent.  I  also  assumed  that  the  medical  pro- 
fession would  eagerly  grasp  the  idea,  put  the 
treatment  into  operation,  to  their  own  benefit 
and  that  of  the  world  at  large,  and  by  the  very 
beneficence  of  their  work  far  more  than  offset 
the  harm  the  charlatans  would  do. 

Both  of  these  assumptions  proved  incorrect. 


PEEVENTIVE  MEASURES         199 

The  fakers  avoided  even  counterfeiting  my 
treatment,  because  the  articles  which  had  an- 
nounced it  in  the  medical  and  lay  press  had 
made  its  brevity  clear  to  the  public ;  they  did  not 
care  to  promote  any  treatment  in  which  their 
victims  would  be  justified  in  demanding  immedi- 
ate relief.  From  that  real  peril  the  community 
was  thus  saved.  But  the  general  indifference 
of  the  medical  profession  was  equally  surpris- 
ing and  at  first  somewhat  discouraging.  I  have 
since  decided,  however,  that  this  was  perhaps 
fortunate ;  for  as  the  work  develops,  it  becomes 
more  and  more  apparent  that  it  is  a  strictly  hos- 
pital treatment,  and  cannot  often  be  successfully 
administered  in  the  environment  of  the  home  or 
in  the  regular  course  of  a  general  practitioner's 
daily  work. 

In  another  part  of  this  book  I  shall  have  more 
to  say  about  the  medical  buzzards  who,  working 
outside  of  medical  ethics  and  in  defiance  of  the 
usually  admirable  spirit  of  the  profession  as  a 
whole,  without  regard  to  financial  or  ethical 
honesty,  indulge  in  whatever  practices  seem  to 
promise  them  the  greatest  profit.  How  danger- 
out  these  men  are  not  only  to  the  patient,  but  to 
the  profession  has  many  times  been  illustrated. 
Various    medical    discoveries    imported    from 


200        HABITS  THAT  HANDICAP 

abroad  or  achieved  and  announced  by  eminent 
American  medical  men  have  brought  flocks  of  un- 
scrupulous practitioners  to  New  York,  not  with 
the  progressive  desire  to  study  and  honestly  ap- 
ply these  new  theories  for  the  benefit  of  their 
patients,  but  with  the  idea  of  learning  barely 
enough  about  them  to  enable  them  to  offer 
credulous  sufferers  cheap  and  worthless  coun- 
terfeits at  exorbitant  rates.  "Where  secret 
methods  have  been  heralded,  they  have  bid 
against  one  another  frantically  to  secure  lo- 
cality privileges,  working  to  this  end  with  all 
the  fierce  competitive  enthusiasm  shown  by 
eager  commercialists  seeking  county  rights  to  a 
practical  and  popular  patent  flat-iron.  It  is  my 
earnest  hope  that  the  wave  of  reform  which  has 
begun  in  New  York  State,  and  which  undoubt- 
edly will  carry  new  and  effective  drug  legisla- 
tion into  every  State  of  the  Union  before  it  loses 
its  forward  impulse,  may  not  revitalize  these 
unworthy  schemers.  It  was  partly  the  hope  of 
preventing  this  evil  that  led  to  the  writing  of 
this  book. 

The  progress  of  intelligent  legislation  will  fill 
the  land  with  much  suffering  from  the  tortures 
of  drug  deprivation.  Therefore  events  have 
placed  a  solemn  obligation  upon  the  medical  pro- 


PREVENTIVE  MEASURES         201 

fession  to  satisfy  itself  of  tlie  efficacy  of  my 
treatment,  even  though  a  new  organization  for 
that  purpose  should  be  necessary.  After  the 
profession  is  assured  of  the  value  of  the  treat- 
ment, many  should  achieve  competence  in  its  ad- 
ministration. Then  it  will  become  a  matter  of 
duty  to  see  that  every  community  is  provided 
with  facilities  and  a  staff  of  experts  sufficient  to 
meet  the  special  needs  that  may  arise  there. 
If  such  an  organization  should  be  formed,  I 
should  be  glad  to  devote  my  services  to  it. 

THE   author's   experience   WITH   THE 
DRUG   HABIT 

My  opportunities  for  observation  in  this  field 
have  extended  over  fourteen  years  of  constant 
study.  They  have  included  investigations  in 
the  Orient  and  Europe  as  well  as  in  the  United 
States,  and  have  dealt  with  patients  of  every 
class.  Early  in  my  work  I  found  it  difficult  to 
secure  subjects,  and  presently  saw  that  I 
could  do  so  only  by  personally  searching  the  un- 
der-world for  them. 

It  was  a  complicated  task,  full  of  unexpected 
problems.  As  I  could  not  engage  salaried 
people  for  the  carrying  out  of  the  details  of  the 
treatment,  it  became  necessary  for  me  to  do 


202         HABITS  THAT  HANDICAP 

everything  except  the  medical  work,  and  to  as- 
sume all  except  the  medical  responsibility. 
But  what  I  at  first  deemed  a  hardship  proved  in 
the  end  to  he  an  advantage,  for  if  I  had  had 
plenty  of  money  with  which  to  carry  on  my 
work,  I  should  never  have  mastered  its  details. 

It  may  be  that  the  need  for  making  the  work 
strictly  self-supporting  from  the  start  led  to  one 
of  my  first  important  psychological  discoveries : 
that  any  person  worth  saving  is  either  able  to 
pay  a  reasonable  amount  for  treatment  or  can 
make  the  price  of  it  a  deferred  obligation  of 
such  a  character  that  it  will  certainly  be  met. 
The  experience  from  which  this  and  other  state- 
ments in  this  book  have  been  deduced  is  not  an 
experience  gained  from  casual  or  even  regular 
daily  calls  of  a  few  minutes  or  a  few  hours  upon 
the  patients  under  treatment,  but  is  due  to  years 
in  which  I  have  frequently  spent  twenty-two 
hours  out  of  every  twenty-four  in  the  same 
building  with  iiiem,  and  subject  to  their  con- 
stant call. 

After  having  proved  the  efficacy  of  treatment 
at  home  it  seemed  advisable  to  make  a  journey 
to  the  Orient,  where  drug  habits  were  notori- 
ously more  common  than  elsewhere.    It  was  the 


PEEVENTIVE  MEASURES         203 

desire  to  study  them  at  first  hand  and  literally 
by  wholesale  which  led  me  to  China,  where  I 
opened  three  hospitals,  and  in  the  course  of 
eleven  months  supervised  the  treatment  for  the 
opium  habit  of  over  four  thousand  Chinese. 
During  this  period  I  treated  all  who  presented 
themselves,  the  ages  of  those  to  whom  relief 
was  given  ranging  from  eighteen  to  seventy-six. 
Among  the  four  thousand  patients  not  one  fa- 
tality occurred,  although  many  of  them  were  ex- 
treme cases,  and  I  was  able  to  obtain  the  assist- 
ance of  only  one  foreign  physician  who  could 
be  considered  responsible.  The  rest  of  the 
work  was  done  by  untrained  Chinese  boys,  who 
administered  the  capsules  at  stated  hours,  and 
not  one  of  whom  was  capable  of  intelligently 
counting  a  patient's  pulse. 

I  have  said  that  not  one  fatality  occurred.  It 
is  pleasant  for  me  to  add  that  during  the  whole 
fourteen  years  of  my  practice,  although  I  have 
had  thousands  under  treatment,  many  of  them 
in  exceedingly  bad  physical  condition  at  the 
time  the  treatment  was  begun,  with  their  drug 
symptoms  complicated  by  various  and  serious 
physical  ailments  and  often  accented  by  alcohol- 
ism, only  four  cases  have  died. 


204        HABITS  THAT  HANDICAP 

SUCCESSFUL  ACHTEVEMENTS  IN   THE   OUEE 
OF  DEUG-USEES 

A  new  precedent  has  been  established  with 
cases  of  this  character  in  the  course  of  my  hos- 
pital experience.  For  the  first  time  the  treat- 
ment has  been  reduced  to  a  definite  hospital 
system,  during  which  the  resident  physician  is 
never  divorced  from  his  patient,  and  in  the 
course  of  which  complete  and  elaborate  bedside 
histories  and  charts  are  kept.  I  have  in  my 
possession  at  the  present  moment  the  complete 
bedside  notes  of  every  patient  to  whom  my 
treatment  has  ever  been  administered.  I  call 
attention  to  this  fact  because  it  shows  that  the 
work  has  not  been  hit  or  miss,  but  has  been  as 
carefully  systematized  and  made  as  highly  sci- 
entific as  it  has  been  possible  to  make  it. 

A  second  precedent  has  been  set,  as  is  proved 
by  the  fact  that  within  a  brief  time  any  case  of 
drug  or  alcoholic  habit  that  is  not  complicated 
by  physical  disabilities  due  to  other  causes  can 
be  successfully  treated  in  a  few  days  without 
heroic  methods  and  without  risk. 

This  has  at  once  proved  the  fallacy  of  old 
methods.  It  has  demonstrated  how  false,  for 
instance,  is  the  principle  of  colonization.    As  I 


PREVENTIVE  MEASURES        205 

have  said,  drug  cases  should  never  be  colonized, 
and  among  alcoholics  only  the  absolutely  hope- 
less inebriate  should  be  subjected  to  this  method 
of  treatment.  With  the  latter,  of  course,  there 
is  no  chance  of  real  relief,  so  that  here  coloniza- 
tion offers  a  means  of  relieving  society  of  all  of 
the  burden  upon  the  police  which  the  inebriate's 
freedom  necessarily  implies,  and  from  a  large 
part  of  the  economic  burden  which  his  existence 
entails  upon  the  community. 

MAKING  SANATOEIUM   CONVICTS 

For  drug-users  colonization  is  the  worst  pos- 
sible treatment  that  can  be  followed.  From 
what  I  know  of  the  conduct  of  the  average  sana- 
torium at  this  time  in  the  United  States,  I  feel 
absolutely  certain  that  no  person  could  possibly 
be  helped  if  sent  there,  and  I  am  convinced  that 
definite  and  virtually  incalculable  harm  would 
be  the  almost  inevitable  result  of  following  such 
a  course.  Drug-users,  as  well  as  alcoholics, 
who  are  sent  officially  or  otherwise  to  institu- 
tions of  this  character  become  what  are  called 
*' sanatorium  convicts."  These  cases  are  vir- 
tually hopeless,  and  are  little  less  pitiable  than 
that  of  the  ^* lifer"  in  a  prison.  There  are  in 
the  United  States  many  people  of  the  better 


206        HABITS  THAT  HANDICAP 

class  who  through  no  fault  of  their  own  have 
became  afflicted  with  the  drug-habit,  and  who 
have  drifted  from  bad  to  worse  until  a  sanator- 
ium has  been  the  only  recourse  left. 

Treatment  for  drug  and  alcoholic  habits  and 
treatment  tending  toward  the  recuperation  of 
the  patient  cannot  be  carried  out  together  with 
one  patient  or  even  simultaneously  with  sev- 
eral patients  in  the  same  institution.  An  un- 
derstanding of  this  fact  has  placed  me  in  an  ad- 
vantageous position  for  giving  advice  about 
whatever  remains  to  be  done  when  a  patient  is 
ready  to  leave  my  hospital.  I  have  always 
worked  in  the  closest  and  most  perfect  harmony 
with  physicians  who  have  sent  cases  to  me  and 
have  never  permitted  any  of  the  doctors  em- 
ployed in  my  institution  to  visit  a  patient  who 
has  left  my  care.  On  the  other  hand,  no  physi- 
cian who  has  brought  a  patient  to  my  hospital 
has  ever  been  divorced  from  him  as  a  result  of 
his  stay  with  us. 

ACCURATE   DIAGNOSIS  POSSIBLE  AFTER   TREATMENT 

Physical  revelations  which  follow  the  unpois- 
oning  of  patients  frequently  startle  the  patients 
themselves  as  well  as  the  physicians  who  have 
their  well-being  in  charge  for  long  periods. 


PEEVENTIVE  MEASURES        207 

Nor  are  the  mental  revelations  less  astonishing. 
There  have  been  many  cases,  after  the  unpoi- 
soning  was  complete,  in  which  a  man  or  woman 
has  been  found  to  be  as  seriously  ailing  mentally 
as  others  have  been  found  ailing  physically. 
Drugs  and  alcohol,  especially  drugs,  have  fre- 
quently been  responsible  for  extraordinary  men- 
tal and  moral  twists.  But  it  must  be  main- 
tained that  the  use  of  drug  or  liquor  is  usually 
the  result  rather  than  the  cause  of  such  condi- 
tions. There  are  many  cases  in  which  no  type 
of  medical  help  will  bring  about  satisfactory 
permanent  results,  though  other  victims,  after 
the  elimination  of  alcohol  or  narcotics,  quickly 
take  their  places  as  useful  and  admirable  mem- 
bers of  society. 

The  problem  confronting  the  physiologist 
after  a  patient  has  been  relieved  of  a  drug  or 
drink  habit  is  comparatively  simple.  If  this  re- 
lief makes  diagnosis  possible  and  reveals  the 
existence  of  an  unsuspected,  but  curable,  ail- 
ment, the  course  to  follow  is  obvious.  With  the 
psychologist  the  problem  is  frequently  far  more 
complicated.  The  useless  citizen  who  becomes 
a  drug-  or  drink-user  will  remain  a  useless  citi- 
zen after  the  drug  or  drink  habit  has  been  elimi- 
nated. 


208        HABITS  THAT  HANDICAP 

To  this  class  belong  most  of  those  who  readily 
relapse  into  their  old  habits  after  their  systems 
have  been  thoroughly  cleared  of  the  physiolog- 
ical demand  for  the  substance  of  their  ha,bit. 
Thus  perhaps  the  most  important  query  the  psy- 
chologist interested  in  this  work  must  ask  after 
the  treatment  of  a  patient  is,  What  is  left  of 
value,  and  what  can  be  done  with  itf  It  is  a 
curious  fact  that  usually  more  is  left  in  the  case 
of  a  poor  than  in  the  case  of  a  rich  patient.  No 
one  is  so  hopeless  as  the  vagrant  rich.  No  man 
will  ever  make  a  reputation  in  work  of  this  char- 
acter who  deals  wholly  or  even  principally  with 
people  to  whom  money  has  no  value. 

UFPOISONING  THE  USER  IS  ONLY  THE  FIEST  STEP 

My  work  has  brought  me  to  the  conclusion 
that  few  physicians  seem  able  accurately  to 
classify  their  own  patients.  Even  the  special- 
ist in  psychology,  who  should  be  able  to  weigh 
all  the  details  of  men^s  mental  and  moral  as 
well  as  physical  being,  seems  likely  to  go  astray 
when  he  considers  a  psychology  that  has  been 
affected  either  by  drink  or  drugs.  Many  physi- 
cians seem  to  be  imbued  with  the  idea  that  after 
a  patient  has  once  been  through  the  process  of 


PREVENTIVE  MEASURES         209 

treatment  for  a  drug  or  drink  habit  lie  will  be 
entirely  made  over;  but  the  fact  is  that  the 
elimination  of  drugs  or  drink  from  a  degener- 
ate will  not  eliminate  degeneracy.  Nothing,  in 
fact,  will  eliminate  it  except  stopping  the  breed- 
ing of  degenerates. 

In  my  work  I  have  found  it  necessary  some- 
times to  seek  advice  from  as  many  as  half  a 
dozen  physical  and  psychological  specialists  in 
connection  with  one  case.  While  instances  have 
been  very  numerous  in  which  several  specialists 
have  been  really  required  for  the  welfare  of  the 
patient,  the  need  had  been  so  thoroughly  con- 
cealed by  the  patient 's  drug  habit  that  it  was  not 
apparent  until  the  effect  of  the  drugs  was  thor- 
oughly eliminated. 

NECESSITY  FOE   CAKEEUL  PSYCHOLOGICAL  STUDY 

In  most  instances  expert  treatment  for  the 
mental  condition  after  drug  or  drink  elimination 
is  as  essential  as  expert  attention  from  the  doc- 
tor of  medicine,  and  if  success  is  to  be  achieved, 
must  be  regarded  as  an  entirely  separate  task. 
Habitual  users  of  drugs  or  drink  are  literally 
human  derelicts.  The  symptoms  of  their  true 
condition  are  submerged,  and  to  clear  them  of 


210        HABITS  THAT  HANDICAP 

their  concealed  weaknesses  it  is  necessary  to 
lift  tliem  like  a  barnacle-ridden  hulk  into  the 
dry-dock  for  investigation  and  repair. 

I  regard  as  a  preferred  risk  among  the  vic- 
tims of  the  drug  habits  those  who  have  acquired 
it  through  the  administration  of  a  narcotic  by 
physicians  in  time  of  pain  or  illness.  Such  a 
case,  if  treated  before  too  great  a  deterioration 
has  taken  place,  may  be  considered  almost  cer- 
tain of  relief,  provided  no  other  ailment  dis- 
closes itself. 

On  the  other  hand,  where  the  drug  habit  is 
the  direct  or  indirect  result  of  alcoholic  dis- 
sipation or  sexual  excesses,  or  is  a  social  vice, 
the  case  is  extra-hazardous.  Here  the  lack  of 
moral  standards  and  the  loss  of  pride  are  seri- 
ous handicaps.  These  matters  are  of  extreme 
importance  to  the  physician  who  is  considering 
the  care  or  treatment  of  cases  of  a  drug  habit. 
That  he  should  classify  his  subjects  of  investi- 
gation, recognizing  the  hopeful  ones  and  ad- 
mitting the  hopeless  to  be  hopeless,  is  essential 
to  successful  work.  He  must  know  the  material 
with  which  he  has  to  work ;  familiarity  with  his 
material  is  as  necessary  to  him  as  it  is  to  the 
carpenter.  Many  cases  have  been  brought  to 
us  that  we  have  declined  to  accept  because  we 


PEEVENTIVE  MEASUEES         211 

could  hope  to  accomplisli  nothing  with  them. 
Not  long  after  I  began  my  work  I  tried  to  help 
a  man  against  my  better  judgment;  I  felt  rea- 
sonably sure  that  he  lacked  the  worthy  qualities 
that  would  make  him  cling  to  and  appreciate 
whatever  advantages  the  treatment  might  af- 
ford. My  estimate  of  his  character  proved  to 
be  correct;  the  man  relapsed,  and  became  a 
traveling  liability  on  me,  a  reproach  against 
my  institution  and  my  treatment. 

THE  HOPELESS  CASE 

I  have  already  said  that  the  idle  rich  to 
whom  money  has  no  value  cannot  usually  be 
classed  among  hopeful  subjects  for  treatment. 
The  same  may  be  said  of  those  for  whom 
others  take  financial  responsibility,  paying  the 
cost  of  their  treatment.  If  such  cases  do  not 
already  belong  in  the  human  scrap-heap,  this 
mistaken  kindness  is  very  likely  to  place  them 
there. 

However,  I  believe  that  those  among  this  class 
who  have  become  public  charges  and  refuse  to 
work  should  be  forced  to  do  so  by  state  or 
municipal  authority.  Society  or  their  own  fam- 
ilies should  not  bear  the  burden  of  their  useless 
existence.    They  should  be  segregated  in  some 


212        HABITS  THAT  HANDICAP 

place  where  they  will  be  physically  comfortable, 
where  they  may  be  made  industrious  and  useful, 
and  where  a  separation  of  the  sexes  will  prevent 
the  increase  of  their  worthless  kind.  My  judg- 
ment is  that  the  man  or  woman  who  through  the 
vagaries  of  his  or  her  own  disposition  has  once 
been  forced  to  wear  the  stripes  of  disgrace  is 
likely  to  employ  the  same  tailor  during  the  rest 
of  his  or  her  life.  Such  persons  will  become 
permanent  boarders  at  one  or  another  of  the 
places  provided  for  the  seclusion  of  the  worth- 
less. It  is  well  that  where  they  are  first  seques- 
trated there  they  should  be  permanently  kept. 
Through  this  course  alone  society  will  be  spared 
the  periodical  havoc  they  will  be  sure  to  work 
during  their  intervals  of  freedom. 

IMPEESONAL   EELATIONS   BETWEEN    PHYSICIAN   AND 

PATIENT   NECESSAET 

Certain  dangers  inevitably  arise  where  an 
intimacy  exists  between  doctor  and  patient, 
since  few  physicians  are  morally  so  constituted 
that  they  will  order  a  prosperous  patient  to  do 
this  or  that  or  find  another  physician.  In  other 
words,  instances  have  not  been  uncommon  where 
the  toleration  of  physicians  for  unfortunate 
practices  among  their  patients  has  had  its  basis, 


PEEVENTIVE  MEASURES         213 

and  perhaps  one  not  entirely  inexcusable  in 
these  days  of  high  pressure  from  professional 
competition,  in  self-interest.  Social  relations 
also  have  often  led  physicians  to  tolerate  prac- 
tices that  they  knew  to  be  harmful  to  their 
patients  and  to  the  community.  A  patient  who 
is  a  member  of  an  influential  club  or  a  fashion- 
able church  is  likely  to  be  an  asset  of  exceptional 
value  to  the  physician  whom  he  patronizes,  for 
he  is  likely  to  recommend  him  to  his  friends. 
Good  business  management  on  the  physician's 
part  leads  him  to  keep  such  a  patient  good 
natured  and  comfortable,  and  to  keep  him  com- 
fortable means,  among  other  things,  to  keep  him 
free  from  pain.  Where  the  patient  suffers 
from  an  incurable  malady,  the  use  of  drugs  is 
not  only  excusable,  but  commendable;  but  in- 
stances are  all  too  frequent  where  the  malady  is 
not  incurable,  but  only  puzzling  and  beyond  the 
average  practitioner's  power  of  diagnosis,  so 
that  he  covers  up  his  ignorance  by  the  adminis- 
tration of  pain-deadening  substances.  Patients 
who  invariably  and  promptly  pay  their  bills  are 
sometimes  in  a  position  where  they  can  tell  a 
doctor  what  to  do ;  whereas  it  should  be  the  doc- 
tor's  unalterable  resolution  to  retain  the  upper 
hand.    Instances  of  this  kind  are  far  less  grave 


214        HABITS  THAT  HANDICAP 

in  connection  with  the  use  of  alcohol  than  in  con- 
nection with  the  use  of  drags ;  the  physician  may 
be  said  almost  never  to  play  any  part  in  the 
establishment  of  an  alcoholic  habit  among  his 
patients,  while  he  has  surely  played  a  most  im- 
portant part  in  the  spread  of  drug  habits. 


CHAPTEE  XII 

CLASSIFICATION  OF  HABIT-FOKMING  DBXJGS 

OPIUM  is  the  basis  of  almost  all  the  habit- 
forming  drugs.  There  is  no  other  drug 
known  to  the  pharmacist  that  has  a  similar 
action  or  can  be  nsed  as  a  substitute  when  a 
definite  tolerance  of  it  has  been  established. 
The  chemists  have  given  us  more  than  twenty 
different  salts  or  alkaloids  of  opium  in  various 
forms  and  under  as  many  different  trade  names, 
and  I  regret  to  say  that  they  are  busy  working 
in  their  laboratories  to  put  upon  the  market  in- 
jurious drugs  under  various  supposedly  harm- 
less disguises,  but  intended  in  the  end  only  to 
deceive. 

MOEPHINE 

Morphine  is  the  active  principle  of  opium, 
and  until  a  few  years  ago  only  crude  opium  or 
morphine  was  used  for  medical  requirements. 
Morphine  is  intrinsically  far  worse  than  opium 
itself,  for  opium  has  certain  properties  which 
partly  counteract  the  effect  of  the  morphine 

215 


216        HABITS  THAT  HANDICAP 

that  it  contains.  But  morpliine  is  not  only  tlie 
active  principle,  but  the  actively  evil  principle, 
of  the  drug. 

The  user  of  morphine  always  retains  his  fac- 
ulties. He  is  usually  capable  of  intelligent  con- 
versation. Unlike  the  alcoholic's  brain,  his  is 
not  inflamed.  It  is  impossible  for  the  physician 
intelligently  to  discuss  his  symptoms  with  an 
alcoholic;  with  a  victim  of  drugs,  on  the  other 
hand,  he  can  thresh  out  every  detail  of  the  case. 

Later  coedine  was  placed  upon  the  market, 
supposedly  an  innocent  alkaloid  of  opium,  non- 
habit-forming,  but  still  capable  of  eliminating 
pain  and  suffering  due  to  illness  or  injury. 
After  taking  up  this  work,  my  investigations 
soon  led  me  to  realize  that  it  was  not  the  quan- 
tity of  the  drug  taken  which  produced  the  drug 
habit,  but  the  regularity  of  the  dosage.  I  also 
found  from  my  clinical  comparisons  that  co- 
deine has  only  one  eighth  the  strength  of  mor- 
phine, yet  in  the  end  just  as  surely  a  producer 
of  the  drug  habit  similar  to  that  of  morphine 
itself. 

HEEOIN" 

At  this  writing  the  most  harmful  form  of 
opiate  with  which  we  have  to  deal  is  heroin. 


HABIT-FORMINa  DEUGS  217 

This  preparation  of  morphine  was  first  put 
upon  the  market  by  German  chemists  about  fif- 
teen years  ago,  the  word  ** heroin"  being  noth- 
ing more  than  a  trade  name.  It  was  first  used 
in  cough  mixtures,  and  was  widely  discussed 
in  the  medical  and  pharmaceutical  press,  where 
it  was  claimed  that  all  the  harm  of  morphine 
had  virtually  been  eliminated  in  this  product, 
which,  without  having  the  depressing  effect  of 
morphine,  at  the  same  time  preserved  its  stim- 
ulating effect.  A  great  number  of  physicians 
themselves  have  acquired  the  habit  of  taking 
opiates  in  this  form,  believing  at  the  outset  that 
they  were  not  harmful  drugs. 

My  investigations  soon  showed  me  that  heroin 
is  three  times  as  strong  as  morphine  in  its  ac- 
tion, and  for  that  reason  its  use  sets  up  definite 
tolerance  more  quickly  than  any  other  form  of 
opiate.  For  the  same  reason  it  shows  more 
quickly  a  deleterious  effect  upon  the  human 
system,  the  mental,  moral  and  physical  deterior- 
ation of  its  takers  being  more  marked  than  in 
the  case  of  any  other  form  of  opiate. 

Until  the  Federal  Pure  Food  Law  was  passed 
we  did  not  know  that  many  of  the  well-known, 
advertised  medical  preparations  contained 
quantities    of   various    salts    or   alkaloids    of 


218        HABITS  THAT  HANDICAP 

opium.  The  unsuspecting  users  of  patent  medi- 
cine were  making  themselves  confirmed  drug- 
users  unwittingly,  and  did  not  realize  how  neces- 
sary the  habit  had  become  to  them  until  for  one 
reason  or  another  they  had  been  deprived  of 
their  usual  daily  dosage. 

The  reader  may  imagine  my  surprise  when, 
although  a  layman,  I  found  that  the  physician, 
to  whom  we  had  looked  for  guidance  in  ad- 
ministering and  prescribing  these  drugs,  knew 
nothing  about  them  beyond  their  physiological 
action;  that  their  medical  training  both  in  col- 
lege and  in  clinics  had  left  them  in  virtual  ig- 
norance of  the  whole  question.  The  physician 
freely  prescribed  or  administered  these  vari- 
ous drugs,  while  laymen  were  able  to  buy  over 
the  counters  of  druggists  prescriptions  con- 
taining definite  quantities  of  them.  Unknow- 
ingly, the  doctor  and  the  druggist  were  creat- 
ing great  numbers  of  drug-fiends. 

Physicians  do  not  yet  know  over  how  long 
a  period  such  drugs  can  be  administered  in 
regular  daily  dosage  without  setting  up  a  toler- 
ance, after  which  the  patient  cannot  be  de- 
prived of  the  drug.  If  the  public  had  been  bet- 
ter advised  on  this  subject,  it  would  have  been 


HABIT-FORMING  DRUaS  219 

able  to  protect  itself,  and  would  have  been 
more  careful  about  what  it  took. 

COCAINE 

Outside  the  opium  group,  there  is  at  present 
only  one  other  drug  that  must  be  considered  as 
habit-forming,  and  that  is  cocaine.  The  prosti- 
tution of  this  drug  from  its  proper  uses  is  ab- 
solutely inexcusable.  It  was  first  used  me- 
dicinally about  thirty  years  ago,  and  as  an 
anesthetic  only.  Its  administration  upon  the 
nose  by  specialists  in  that  field  of  surgery  soon 
established  the  fact  that  it  not  only  deadened 
tissue,  but  set  up  a  certain  stimulation  which 
for  the  time  being  made  one  feel  abnormally 
strong  or  mentally  active.  This  was  the  begin- 
ning of  its  common  use  in  the  shape  of  so- 
called  catarrh  cures.  Only  a  small  quantity 
— from  five  to  ten  per  cent. — ^was  used.  The 
tissue  of  the  nose  is  very  susceptible  to  the 
action  of  drugs.  When  it  is  applied  in  this 
way,  the  circulation  takes  up  the  drug  as  quickly 
as  if  taken  hypodermically.  Unscrupulous 
chemists  and  physicians  have  unloaded  upon  the 
world  a  drug  which  is  beneficial  when  taken 
medicinally,  but  one  that  has  reaped  a  harvest 


220        HABITS  THAT  HANDICAP 

of  irresponsible  victims,  in  wMcli  murder,  all 
forms  of  crime,  and  mental  and  moral  degen- 
eracy have  conspicuously  figured,  and  all  for 
financial  gain. 

The  habit  was  first  generally  spread  through 
the  medium  of  catarrh-cures.  Cocaine  con- 
tracts and  deadens  the  tissue  with  which  it 
comes  in  contact,  and  thus,  as  in  the  case  of 
catarrh,  relieves  the  patient  from  discomfort, 
making  him  feel,  indeed,  as  if  there  were  no 
nose  on  his  face.  Its  effect,  however,  lasts  only 
from  twenty  to  thirty  minutes. 

This  is  one  of  the  reasons  why  the  cocaine 
habit  is  so  easily  formed.  A  man  taking  any 
powerful  stimulant  is  sure  to  feel  a  correspond- 
ing depression  when  the  effect  of  that  stimulant 
has  died  away,  and  it  then  becomes  necessary 
for  him  to  take  more  of  the  drug  in  order  to  buoy 
himself  up  and  restore  himself  to  the  point  of 
normality.  It  is  among  cocaine-users,  there- 
fore, not  a  yearning  for  any  abnormally  pleas- 
urable sensation  which  sends  them  back  again 
and  again  to  their  dosage,  but  merely  their  de- 
sire to  be  measurably  restored  to  the  comfort 
which  is  natural  to  the  normal  state.  It  must 
be  apparent,  however,  that  as  soon  as  it  has  be- 


HABIT-FORMING  DEUGS  221 

come  necessary  for  any  one  to  resort  to  the  use 
of  a  drug  in  order  to  rise  to  the  normal  there 
has  been  a  marked  depreciation,  physical  or 
mental,  and  probably  both.  This  explains  the 
fact  that  many  criminals  are  found  to  be  cocaine- 
users.  No  drug  so  quickly  brings  about  a  men- 
tal and  physical  deterioration.  It  is  virtually 
certain  to  be  a  short  cut  to  one  of  two  public 
institutions,  the  prison  or  the  madhouse.  It 
will  send  the  average  person  to  the  prison  first 
because  it  is  an  expensive  drug,  and  the  crav- 
ing for  it  is  more  than  likely  to  exhaust  his 
financial  resources  and  then  drive  him  to  theft. 
It  is  the  most  expensive  of  all  drug  habits.  I 
have  known  victims  who  habitually  used  one 
hundred  and  twenty  grains  a  day,  at  a  cost  of 
about  seventy  dollars  a  week.  This  undoubt- 
edly explains  the  great  number  who  have  been 
made  criminals  by  using  cocaine.  One  who  uses 
it  thereby  diminishes  his  earning  capacity; 
while,  on  the  other  hand,  one  who  must  have  it 
must  have  money,  and  much  of  it. 

It  may  be  that  this  matter  of  cost  explains 
why  the  under-world  has  suddenly  taken  up 
heroin  instead  of  cocaine.  The  former  is  much 
cheaper. 


222        HABITS  THAT  HANDICAP 

HYPNOTICS 

While  I  have  only  touched  upon  the  opium 
group  and  cocaine,  I  wish  to  put  myself  on  rec- 
ord now  as  saying  that  there  is  no  class  of  drugs 
so  sure  in  the  end  to  bring  about  a  deterioration 
of  the  physical  being  as  the  frequent  use  of  the 
hypnotic  group,  or  coal-tar  products,  the  sleep- 
producers.  I  have  never  seen  more  pitiable 
cases  than  those  who  have  come  to  me  after  they 
had  been  taking  regularly,  during  a  considerable 
period,  some  cure  for  sleeplessness.  This  habit 
not  only  produces  an  extreme  neurotic  condi- 
tion, but  changes  the  entire  temperament  of  a 
person.  It  will  turn  the  most  beautiful  charac- 
ter into  an  extreme  case  of  moral  degener- 
acy. 

Insomnia,  headaches,  and  such  ailments  spring 
from  a  disorganized  physical  condition.  Try- 
ing to  alleviate  them  by  the  use  of  powerful 
drugs  does  not  remove  the  cause,  but  compounds 
the  physical  disabilities  which  produce  these  un- 
fortunate physical  results.  Some  day  I  hope  to 
see  as  stringent  a  legal  regulation  of  the  sale 
of  these  drugs,  used  for  this  common  purpose,  as 
there  now  is  of  opium  and  its  products  and 
cocaine. 


HABIT-FOEMING  DEUGS  223 

SLEEPING-POWDERS,  OB  HYPNOTICS 

The  time  cannot  be  far  distant  when  both  Fed- 
eral and  State  governments  will  recognize  the 
danger  that  lies  in  the  unrestricted  sale  by  drug- 
gists and  the  uncurbed  administration  by  phy- 
sicians of  sleeping-powders,  or  hypnotics.  It 
cannot  be  denied  by  any  one  who  is  thoroughly 
familiar  with  the  subject  of  habit-forming  drugs 
that  in  such  substances  may  lie  a  peril  compara- 
ble to  that  inherent  in  cocaine  and  opium  com- 
pounds. Hypnotics  of  many  varieties  can  be 
obtained  at  any  drug  store  in  the  United  States 
without  a  doctor's  certificate.  The  sale  of  bro- 
mides is  absolutely  unrestricted.  The  many  and 
varied  coal-tar  products,  of  which  veronal  is  the 
leader,  with  trional,  suphonal,  medinal,  as  close 
followers,  and  the  numerous  proprietary  rem- 
edies, such  as  somnose,  neuronidia,  bromidia, 
Peacock's  bromides,  etc.,  may  be  mentioned  as 
preparations  which  are  widely  advertised  and 
openly  and  energetically  sold,  and  all  of  which 
are  definitely  dangerous. 

COAL-TAR  PRODUCTS 

Preparations  for  headaches  and  neuralgia  are 
notably  dangerous.    There  can  be  no  doubt  of 


224        HABITS  THAT  HANDICAP 

the  necessity  for  legal  restriction  of  the  sale  of 
anti-kamnia,  phenalgin,  orangeine,  Koehler's 
headache  remedy,  shac,  all  coal-tar  products 
notable  for  their  production  of  anemia  and 
depression,  and  undoubtedly  responsible  for 
the  presence  of  many  men  and  women  in  the 
mad-houses  of  the  land.  The  chemist  whose 
genius  is  responsible  for  the  introduction  of 
caffeine  to  overcome  the  depressing  effect  of 
some  of  the  other  component  parts  of  these  prep- 
arations has  put  hundreds  of  thousands  of  dol- 
lars into  the  pockets  of  the  manufacturing  drug- 
gists and  has  saddled  the  world  with  a  great 
and  unnecessary  weight  of  physical  and  mental 
degeneration. 

THE  PEKIL  OF   THE  DEUG-STOEE 

Not  least  among  these  preparations  that  have 
most  importantly  contributed  to  the  tragic  army 
of  drug-users  in  the  United  States  have  been 
various  diarrhea  remedies  and  other  bowel  cor- 
rectives containing  a  large  amount  of  straight 
opium.  Morphine,  opium,  and  heroin  appear  in 
many  cough-mixtures  in  habit-forming  quanti- 
ties and  are  offered  for  sale  everywhere  save 
in  New  York  State,  where  recent  legislation 
somewhat  restricts  the  traffic.    Indeed,  in  every 


HABIT-FORMING  DRUGS  225 

State  except  New  York  there  are  few  druggists 
who  do  not  make  up  and  sell  preparations  of 
their  own  containing  codeine,  morphine,  heroin, 
or  some  of  the  derivatives  of  opium. 

No  druggist  has  a  right  to  prescribe  any  of 
these  powerful  drugs.  The  American  public 
has  fallen  into  the  bad  habit  of  trusting  the  drug- 
gist when  it  should  go  to  the  physician.  A 
dozen  times  every  day  in  the  experience  of  the 
average  American  druggist  a  customer  enters 
who  says,  ''I  want  something  to  make  me  sleep," 
or,  ''I  want  something  to  cure  my  headache." 
Without  hesitation,  and  without  blame,  for  with 
him  the  custom  has  probably  been  unconsciously 
built  up,  the  druggist  reaches  to  his  shelf  and 
dispenses  preparations  in  which  the  utmost  peril 
lurks — ^preparations  containing  ingredients 
which  should  be  sold  only  on  the  prescription 
of  a  physician.  Under  the  present  law,  as  I 
think  it  exists  in  every  State,  druggists  cannot 
prescribe,  but  they  can  advise  customers  to  pur- 
chase advertised  preparations  and  those  which 
they  themselves  compound. 

Only  a  very  powerful  drug  can  stop  a  head- 
ache as  quickly  and  completely  as  Americans 
have  come  to  demand.  The  preparation  must 
be  strong  enough  to  deaden  disordered  nerves, 


226        HABITS  THAT  HANDICAP 

and  being  chosen  because  it  will  be  generally 
effective,  not  selectively  effective,  as  in  the  case 
of  a  remedy  chosen  after  an  intelligent  diagnosis 
has  revealed  the  nature  of  the  trouble  to  be 
treated,  it  is  virtually  certain  to  have  no  cura- 
tive qualities  whatever.  Hundreds  of  deaths 
have  resulted  from  unwisely  experimenting  with 
such  preparations.  Most  of  us  have  peculiar 
idiosyncrasies  with  regard  to  certain  drugs.  I 
have  seen  patients  who  could  not  take  so  much 
as  two  grains  of  veronal  or  trional  without  flush- 
ing, itching,  and  similar  symptoms.  With  such 
people  large  doses  might  bring  about  serious 
results  and  even  death. 


CHAPTEE  XIII 

PSYCHOLOGY  OF  ADDICTION 

THE  common  idea  tliat  one  who  is  struggling 
with  a  drag  or  alcohol  habit  needs  sym- 
pathy and  psychological  encouragement  is  to- 
tally at  variance  with  the  facts.  No  one  has 
ever  accomplished  anything  worth  while  by 
holding  the  hand  of  an  alcoholic,  and  any  one 
who  is  endeavoring  to  help  a  case  of  this  sort 
will  find  himself  instantly  and  seriously  handi- 
capped if  he  puts  himself  in  intimate  personal 
relationship  with  his  patient.  Social  inter- 
course in  any  degree  should  be  tabooed.  The 
physician  should  never  take  a  meal  with  any  of 
his  patients,  or  visit  a  theater  with  them,  or  take 
a  drive  with  them.  I  have  never  made  a  friend 
of  one  of  my  patients,  although  among  them 
have  been  many  whom  I  should  be  glad  to  num- 
ber among  my  friends;  and  no  man  would  go 
further  to  help  them  than  I. 

Personally,  I  have  never  been  an  excessive 
alcoholic.    It  is  an  interesting  fact  that  many 

227 


228         HABITS  THAT  HANDICAP 

men  endeavoring  to  deal  with  people  of  this  class 
use  as  a  bait  the  statement  that  they  themselves 
have  been  victims.  Their  usual  claim  is  that 
they  first  cured  themselves,  and  then  took  up  the 
work  of  curing  others.  I  remember  a  meeting 
of  social-service  workers  in  Boston  that  I  was 
invited  to  address.  I  made  a  statement  to  this 
effect  in  the  course  of  my  talk  and  greatly  of- 
fended a  previous  speaker  who  had  emitted  the 
usual  professional  patter  concerning  his  original 
self -cure.  I  was  quite  willing  to  compare  with 
him  the  results  of  our  methods  of  treatment,  but 
had  no  opportunity  so  to  do. 

HEREDITARY   TEN-DENCIES   TOWARD  ADDICTION 
AKT   IMPOSSIBILITY 

It  is  absolutely  essential  that  the  man  who 
wishes  to  help  another  who  has  lost  control  must 
first  accurately  understand  not  only  his  mental 
imperfection,  if  there  is  any,  but  his  general 
psychological  state.  The  line  between  sobriety 
and  drunkenness  in  the  man  who  has  once  lost 
control  is  almost  indistinguishable ;  it  is  impos- 
sible when  talking  with  him  to  be  sure  whether 
you  are  talking  with  the  normal  mind  or  with 
the  alcoholic  mind.  Having  once  made  certain 
that  it  is  the  normal  mind  to  which  you  are  pre- 


PSYCHOLOGY  OF  ADDICTION     229 

senting  your  arguments,  your  next  necessary 
step  is  to  strip  away  every  mental  reservation. 
Thousands  of  men  who  have  honestly  desired  to 
leave  off  alcohol  have  been  prevented  from  doing 
so  by  their  own  secretiveness ;  it  is  this  mental 
reservation  which  has  been  responsible  for  many 
of  the  failures  of  my  treatment. 

While  the  absolute  inheritance  of  a  craving  for 
alcohol  is,  in  my  experience,  a  rare  thing — so  rare 
as  to  seem  almost  negligible,  there  is  no  doubt, 
on  the  other  hand,  that  many  men  and  women 
inherit  imperfect  nervous  systems.  An  imper- 
fect nervous  system,  if  it  knew  the  reason  for 
its  own  imperfections,  might  naturally  crave  al- 
cohol ;  but  inasmuch  as  such  an  imperfect  system 
is  not  naturally  accompanied  by  this  instinctive 
knowledge,  the  theory  of  hereditary  alcoholic 
craving  must  be  set  aside  as  untenable.  I  abso- 
lutely deny,  therefore,  the  possibility  of  such 
hereditary  tendencies.  I  know  that  by  so  doing 
I  may  cause  acute  mental  discomfort  to  those 
who  have  made  of  heredity  an  excuse  for  their 
errors  not  only  to  their  friends,  but  in  their  own 
minds.  The  old  cloak  of  heredity  has  been  worn 
to  tatters  and  must  be  discarded.  Who  among 
us  cannot  follow  up  the  branches  of  his  family- 
tree  and  find  somewhere  upon  one  side  or  the 


230         HABITS  THAT  HANDICAP 

other  a  person  of  alcoholic  tendencies?  In 
ninety  families  out  of  a  hundred  any  one  who 
looks  can  find  such  an  excuse  for  his  own  weak- 
ness. In  thousands  of  instances  physicians 
have  taken  seriously  such  excuses  offered  by 
their  patients,  but  the  doctor  who  listens  to  his 
patient 's  babble  of  heredity  is  sure  to  be  misled, 
and  the  patient  who  believes  this  too  commonly 
accepted  theory  robs  himself  of  his  strongest 
weapon  against  alcohol — his  own  conviction  of 
his  personal  responsibility  and  power  for  self- 
help. 

ALCOHOLISM  AS  A  DISEASE 

We  hear  much  sympathetic  talk  of  the  ''dis- 
ease of  alcoholism."  This  is  only  in  a  sense 
true.  It  is  not  a  case  of  helpless  chance,  for  the 
difficulty  has  been  manufactured  and  developed 
by  man  himself.  The  alcoholic,  mentally  weak- 
ened by  the  reaction  of  the  stimulant,  is  of  all 
people  most  likely  to  exhibit  that  most  striking 
evidence  of  weakness — a  craving  for  sympathy 
rather  than  for  blame.  Habitual  alcoholics  con- 
tinually plead  for  sympathy  with  mothers,  fa- 
thers, wives,  and  friends ;  and  too  often  they  are 
granted  not  only  pity,  but,  what  is  worse,  tolera- 
tion.   The  sanatorium  promoters  and  proprie- 


PSYCHOLOGY  OF  ADDICTION     231 

tors  of  fake  cures  continually  harp  on  alcoholism 
as  a  disease;  and  even  a  few  scientists,  who 
should  know  better,  have  been  misled  into  an  ac- 
ceptance of  this  theory.  Doctors  should  be  the 
first  to  knock  from  under  their  patients  the  psy- 
chologically harmful  props  of  the  heredity  theo- 
ries. 

The  first  thing  a  physician  must  do  when  deal- 
ing with  an  alcoholic  is  to  cut  every  string  of 
excuse  which  lies  between  him  and  his  habit. 
He  must  leave  nothing  of  this  sort  to  which  the 
drinker  may  cling.  Sickness,  worry,  unhappy 
circumstances  of  whatever  sort  must  immedi- 
ately be  eliminated  as  excuses  for  alcoholic  in- 
dulgence. If  they  are  not,  the  patient,  although 
he  may  gain  for  a  time  the  mastery  over  his 
habit,  will  presently  be  certain  to  find  an  excuse 
in  his  own  mind  to  justify  a  return  to  it.  Then 
will  come  a  new  downfall.  There  must  be  no 
reservations  either  in  the  attitude  of  the  doctor 
or  his  patient  or  in  the  mental  attitude  of  the 
patient  toward  himself. 

MENTAL   ATTITUDE   A   VITAL   CONSIDEBATION 

The  possibilities  of  medical  help  for  the  alco- 
holic have  been  exhausted  when  the  patient  has 
been  freed  from  the  effect  of  the  stimulant  and 


232        HABITS  THAT  HANDICAP 

put  in  a  physical  condition  wherein  lie  feels  no 
inclination  toward  more  alcohol.  Great  psycho- 
logical assistance  may  accompany  this  definite 
medical  treatment  when  the  patient's  physical 
craving  for  alcohol  has  once  been  eliminated  if 
the  physician  brings  him  into  a  mental  state 
which  gives  him  confidence  in  his  own  ability  to 
keep  away  from  stimulants  in  the  future. 

I  cannot  too  strongly  emphasize  the  fact  that 
no  cure  exists,  or  ever  will  exist,  for  alcoholism. 
Its  effects  may  be  eliminated,  and  the  victim's 
physical  condition  become  so  greatly  improved 
that  weakness  will  not  make  him  yearn  for  stim- 
ulation; but  this  does  not  constitute  a  cure. 
Nothing  except  a  man's  own  mind,  whether  the 
treatment  extends  over  six  weeks,  six  months,  or 
six  years,  can  ever  relieve  him  of  the  danger  of 
a  relapse  into  alcoholism.  In  most  cases  a  defi- 
nite medical  treatment  is  the  intelligent  begin- 
ning of  help,  but  no  medical  treatment,  no  mat- 
ter how  successful,  can  compass,  that  victory 
which  a  man  must  win  by  means  of  his  own  de- 
termination. 

THE    CHRONIC   ALCOHOLIC 

The  physician  still  regards  such  cases  only 
from  the  point  of  view  of  physical  hazard,    It 


PSYCHOLOGY  OF  ADDICTION     233 

is  my  opinion  that  in  alcoholic  cases  the  physical 
hazard  is  the  matter  of  least  importance,  and 
that  the  world  at  large  has  devoted  altogether 
too  much  effort  to  its  endeavors  to  preserve 
chronic  alcoholics,  just  as  it  has  devoted  far  too 
little  effort  to  rescue  the  victims  of  drugs.  It 
is  my  opinion  that  among  alcoholics,  no  matter 
how  worthy  they  may  have  been  before  they  lost 
control,  not  more  than  twenty-five  per  cent,  of 
those  whose  addiction  has  become  chronic  are 
curable;  that  is  to  say,  promise  any  reward 
whatever  for  salvage  work.  The  world  must 
remember  that  the  inflamed  brain  leads  to  every- 
thing on  earth  which  is  not  worth  while,  and 
therefore  that  the  man  whose  brain  has  for  any 
considerable  period  of  time  been  in  this  condi- 
tion must  have  enormously  deteriorated.  It 
must  also  be  remembered  that  at  least  one  half 
of  the  world's  chronic  alcoholics  have  syphilitic 
histories. 

The  alcoholic  is  usually  susceptible  to  the  ad- 
vances of  any  woman  whatsoever,  and  as  a  rule 
devotes  less  than  the  normal  attention  to  his 
own  wife.  To  set  out  to  reclaim  a  chronic  alco- 
holic is,  therefore,  to  set  out  to  reform  a  man 
who  has  been  weakened  morally  and  mentally  as 
well  as  physically.    In  dealing  with  such  people, 


234         HABITS  THAT  HANDICAP 

were  the  matter  left  entirely  to  me,  drastic  meas- 
ures would  be  taken.    It  is  my  belief  that  the 
hopeless  inebriate  should  be  unsexed,  not  be- 
cause of  the  danger  that,  if  left  sexually  normal, 
he  might  transmit  his  alcoholic  tendencies  by 
heredity  to  his  offspring,  but  because  he  is  a  lia- 
bility at  best,  and  to  leave  him  normal  adds  to 
his  potentiality  for  waste  and  evil.    Children 
born   of   alcoholic-tainted   parentage   are   not 
specially  likely,  I  think,  to  yield  to  alcoholic 
and  tobacco  tendencies;  but  they  are  apt  to 
lack  vitality  and  mental  stamina,  so  that  the 
probability  of  their  making  worthy  records  is 
small.    If  we  go  one  step  beyond  syphilis  and 
consider  other  venereal  diseases,  we  shall  un- 
doubtedly discover  that  not  twenty-five,  but 
ninety,  per  cent,  of  chronic  alcoholics,  excluding 
women,  have  been  victims  of  gonorrhoea.    I  am 
told  that  modern  science  is  recognizing  this  dis- 
ease, which  was  once  regarded  as  of  slight  im- 
portance, an  inevitable  experience  of  youth,  and 
something  to  be  accepted  and  regarded  lightly, 
as  an  ailment  of  nearly  as  vicious  an  influence 
upon  the  race  as  is  syphilis.    Therefore  I  have 
become  convinced  that  the  salvage  of  alcoholic 
derelicts  is  of  vastly  less  importance  than  pre- 
vention at  the  outset.    This  principle  is  being 


PSYCHOLOGY  OF  ADDICTION     235 

more  and  more  generally  recognized  throughout 
the  world;  it  stands  behind  sanitation  and  all 
preventive  medicine,  and  it  will  before  long  be 
recognized  in  connection  with  the  problem  of 
alcohol.  Thus  the  battle  against  alcohol  will  be- 
come, as  the  battle  against  tuberculosis  has  be- 
come, a  campaign  of  education. 

It  is  my  belief  that  every  community  should 
have  an  institution  in  which  hopeless  inebriates 
may  be  kept  away  from  their  cups  and  away 
from  sexual  association.  There  they  should  be 
put  at  useful  occupations ;  full  advantage  should 
be  taken  of  whatever  productive  capacity  alcohol 
may  have  left  in  them ;  and  they  should  be  main- 
tained in  a  state  as  happy  as  their  capabilities 
may  permit  until  they  mercifully  die.  Their 
segregation  would  not  prevent  hereditary 
drunkenness,  for  there  is,  as  I  have  said,  no 
such  thing  as  an  hereditary  drunkard,  but  it 
would  prevent  the  transmission  of  imperfect 
nervous  systems,  and  depleted  intellect  and  will 
power. 

SELF-COITFIDENCE   NECESSAKY 

Involved  in  helping  these  cases,  my  investiga- 
tions have  shown  me  that  when  once  it  is  deter- 
mined on  reasonable  evidence  that  a  man  is 


236        HABITS  THAT  HANDICAP 

curable,  the  first  effort  should  be  devoted  to 
reestablishing  his  confidence  in  himself.  He 
should  be  *' given  a  new  mind"  upon  the  sub- 
ject of  drink  and  general  self-indulgence.  It 
does  little  good  to  free  a  man  from  alcohol  if 
his  mental  state  is  so  poor  that  he  will  celebrate 
this  boon  by  again  making  himself  a  voluntary- 
victim  of  the  habit.  It  is  for  this  reason  that  I 
have  found  the  least  hopeful  work  in  reclamation 
to  be  that  which  is  conducted  among  the  idle 
rich.  The  alcoholic  idle  poor  are  virtually  hope- 
less ;  the  alcoholic  idle  rich  are  absolutely  hope- 
less. To  the  reform  of  the  drunkard  mental 
and  physical  occupation  and  some  sense  of  moral 
responsibility  are  imperative.  It  is  because  of 
these  things  that  I  have  deliberately  and  per- 
sistently refused  to  use  the  word  ''cure"  in  con- 
nection with  my  treatment.  A  man  cannot  be 
cured  of  alcoholism.  He  can  be  given  medical 
aid  which  will  restore  his  self-control. 

The  ordinary  methods  in  vogue  for  the  recla- 
mation of  alcoholics  are  pitifully  futile.  The 
greatest  mistake  of  all  is  that  workers  never  fin- 
ish with  those  whom  they  are  endeavoring  to 
help.  One  must  finish  with  the  alcoholic 
promptly  and  conclusively.  I  have  found  that 
alcoholics  taking  treatment  at  my  hospital  must 


PSYCHOLOGY  OF  ADDICTION     237 

understand  that  I  do  not  wish  to  hear  from  them 
after  they  have  left  my  care ;  that  I  do  not  wish 
to  know  if  they  have  yielded  to  new  madnesses 
and  relapsed  into  alcoholism.  It  is  specially  im- 
portant for  an  alcoholic  to  learn  that  at  a  certain 
point  society  will  have  had  enough  of  him.  Fa- 
thers must  break  with  alcoholic  sons  and  daugh- 
ters, mothers  must  break  with  alcoholic  children, 
wives  and  husbands  must  be  freed  from  alco- 
holic mates,  charitable  institutions  must  be  rid 
of  alcoholic  derelicts.  Society  itself  must  be 
rid  of  this  waste  material,  after  it  has  ascer- 
tained that  their  cases  are  hopeless  and  has  pro- 
vided comfortable  sequestration  for  them. 

THE  DRUNKARD  WHO   CAN  BE  SAVED 

Now  let  us  turn  to  the  vast  army  of  people 
who  are  worth  while,  but  who,  nevertheless, 
have,  through  mistakes  common  to  our  society, 
become  victims  of  the  alcoholic  habit.  It  would 
almost  seem  that  the  incurables  among  alcoholics 
have  received  more  consideration  from  the 
kindly  minded,  and  even  from  the  scientifically 
inclined,  than  have  the  curables.  The  curable 
among  alcoholics  are  intense  and  pitiable  suf- 
ferers. They  have  never  had  real  help.  They 
have  been  penalized.    The  poor  among  them 


238        HABITS  THAT  HANDICAP 

have  been  colonized  in  harmful  state  institu- 
tions by  the  public  authorities ;  the  rich  among 
them  have  been  placed  in  equally  harmful  pri- 
vate institutions  by  their  relatives  and  friends. 
The  alcoholic  who  is  punished  by  incarceration 
in  a  cell  is  harmed,  not  helped,  by  it;  the  man 
who,  on  the  mythical  chance  of  reform  is  shunted 
off  to  a  state  establishment,  or  who  is  sent 
by  prosperous  friends  to  board  at  some 
expensive  sanatorium,  stands  to  lose,  not  gain, 
by  his  experience.  These  methods  merely 
beg  the  question.  They  recognize  the  drunk- 
ard as  a  liability  and  put  him  out  of  sight; 
they  do  nothing  toward  his  real  regeneration. 
The  inebriates '  farm  is  based  on  the  same  utter 
misconception  as  the  fashionable  sanatorium  to 
which  the  rich  man's  son  may  be  committed. 
An  intelligent  handling  of  this  subject  would 
close  or  entirely  reform  ninety-nine  per  cent,  of 
the  public  institutions  devoted  to  the  care  of 
inebriates,  and  would  depopulate  one  half  of  the 
sanatoriums  between  the  Atlantic  and  the  Pa- 
cific. To  put  a  poor  man  to  sober  up  on  a  farm 
where  the  State  will  pay  his  board  and  expect 
him  not  to  become  an  active  menace  to  society  as 
soon  as  the  period  of  his  sequestration  comes  to 
an  end  is  no  more  foolish  than  to  put  the  rich 


PSYCHOLOOY  OF  ADDICTION     239 

man's  son  into  a  private  institution  where  lie 
will  be  petted,  coddled,  and  retained  at  the  high- 
est rates  as  long  as  possible,  and  from  which 
he  will  be  eventually  permitted  to  return  to  his 
old  haunts  freed  from  the  immediate  physical 
discomforts  of  his  past  alcoholism  and  therefore 
provided  with  a  fresh  capacity  for  strong  drink 
and  rejuvenated  powers  for  evil-doing.  Placing 
a  drunken  young  man  in  a  sanatorium  where 
some  one  will  pay  his  board  while  he  lives  in 
utter  idleness  is  certain  not  to  correct,  but  to 
complete,  the  evil  work  which  has  been  started 
in  him ;  and  thus  in  many  cases  the  very  means 
adopted  by  friends  and  parents  for  the  benefit 
of  those  they  love  are  likely  to  increase  rather 
than  to  decrease  their  ultimate  tendency  toward 
dissipation. 

Nothing  can  be  much  more  pitiful  than  the 
spectacle  of  a  youngster  led  into  an  alcoholic 
addiction  through  the  influence  of  older  men. 
I  am  by  no  means  accepting  the  theory  of  heredi- 
tary drunkenness  when  I  say  that  many  young 
drunkards  are  only  faithfully  following  their 
fathers'  footsteps,  and  cannot  be  justly  blamed 
for  their  error.  Too  often  it  is  true  that  they 
literally  find  themselves  unable  to  catch  up  with 
their  fathers  in  alcoholic  exploits,  because  their 


240        HABITS  THAT  HANDICAP 

constitations,    depleted    by    vicious    parental 
habits,  prove  too  weak  to  stand  the  pace. 

Even  where  boys  are  not  unfortunately  influ- 
enced by  vicious  examples  offered  by  their  par- 
ents, there  are  circumstances  of  our  modem  life 
that  are  likely  to  work  havoc  with  the  rising  gen- 
eration. The  youth  who  up  to  his  twenty -first 
birthday  has  been  permitted  to  "have  his  own 
way"  is  not  likely  to  have  formed  the  habit  of 
traveling  in  a  very  good  way;  nor  will  he  be 
likely  to  change  it  for  a  better  one  when  it  is 
proved  to  him  and  to  his  friends  and  to  society 
that  it  is  bad ;  for  habits  form  early.  Associa- 
tion with  thousands  of  those  who  have  gone 
wrong  has  proved  many  social  facts  to  me,  one 
of  which  I  mention  here  despite  its  apparent  ir- 
relevance. The  boy  who  has  never  known  the 
value  of  money,  on  whom  the  responsibilities  of 
life  have  never  been  impressed,  is  as  seriously 
uneducated  as  he  would  be  if  lack  of  common 
schooling  had  left  him  illiterate. 


CHAPTER  XIV 

RELATION-   OF   DRUGS   AND   ALCOHOL   TO   INSANITY 

THE  habitual  drug-taker  and  the  confirmed 
alcoholic  are  puzzles  that  baffle  the  alienist. 
The  man  with  the  ' '  wet  brain"  is  a  contradiction 
of  all  the  rules  of  normality.  In  many  criminal 
trials  men  have  been  adjudged  insane  who  were 
merely  in  abnormal  states  due  to  the  habitual 
use  of  drugs  or  alcohol,  of  which,  without  proper 
treatment,  they  have  been  suddenly  deprived. 

In  one  of  the  largest  hospitals  in  the  United 
States  I  once  ran  across  an  old  woman  crooning 
while  she  rocked  an  imaginary  baby.  She  had 
been  formally  and  legally  adjudged  insane  by 
the  State's  experts.  As  a  matter  of  fact,  she 
was  suffering  only  from  an  hallucination  due 
to  alcoholic  deprivation.  I  suggested  definite 
medical  treatment  for  this  case  when  I  discov- 
ered that  she  was  about  to  be  transferred  from 
the  alcoholic  ward  to  the  insane  pavilion.  In 
two  days  after  the  administration  of  this  treat- 

241 


242         HABITS  THAT  HANDICAP 

ment  she  had  lost  all  her  hallucinations,  and  on 
the  third  day  was  dismissed  from  the  institu- 
tion. Not  long  ago  I  observed  a  similar  case  in 
a  foreign  hospital. 

It  is  my  belief  that  commitments  for  insanity 
in  the  United  States  might  be  decreased  by  one 
third  if  in  every  case  where  insanity  was  sus- 
pected, but  where  an  alcoholic  or  drug  history 
could  be  traced,  the  patient  should  be  subjected 
to  the  necessary  medical  treatment  before  the 
final  commitment  was  made.  The  sudden  depri- 
vation of  drugs  and  alcohol  which  follows  the 
imprisonment  of  alcoholics  and  drug-users  upon 
disorderly  or  criminal  charges  has  produced 
thousands  of  cases  of  apparent  insanity  suffi- 
ciently marked  for  the  subjects  to  be  placed  in 
insane  asylums.  There,  as  in  the  prison,  no 
intelligent  note  is  made  of  their  condition,  nor 
is  any  proper  treatment  applied,  the  result  being 
that  they  become  really  insane — insane  and 
hopeless.  If  we  had  any  means  of  securing  ac- 
curate knowledge  of  the  number  of  such  incur- 
able maniacs  who  are  now  confined  in  our 
asylums,  we  should  find  in  it  a  startling  evidence 
of  the  lack  of  knowledge  on  the  part  of  the 
medical  world  of  what  deprivation  means  to  the 
habitual  victim  of  drugs  or  alcohol. 


DEUGS  AND  INSANITY  243 

GENEEAL   IGNOBANCE   OP   THE   KELATION   OE 
ADDICTION   TO   INSANITY 

The  necessity  for  educating  the  public  in 
regard  to  the  very  definite  relation  between  al- 
coholism and  insanity  should  no  longer  be  over- 
looked. There  lies  a  public  peril  of  unap- 
preciated magnitude  in  the  fact  that  mere 
deprivation,  the  only  method  so  far  followed, 
has  been,  and  if  it  is  not  corrected,  will  continue 
to  be,  one  of  the  principal  feeders  of  our  insane 
asylums.  Alcoholism  will  lead  to  insanity  even- 
tually even  without  deprivation. 

The  case  is  somewhat  different  with  drug  vic- 
tims. Ordinarily  they  will  not  become  insane 
unless  deprived  of  their  drug,  although  in  the 
final  stages  of  the  habit  they  are  likely  to  become 
incompetent  and  subject  to  certain  hallucina- 
tions, imagining  the  existence  of  plots  against 
them,  suspecting  unfairness  on  every  hand,  tak- 
ing easy  offense,  exhibiting,  in  fact,  a  general 
distorted  mental  condition.  It  is  true,  indeed, 
that  in  some  instances  the  drug  victim  who  is 
deprived  of  his  drug  may  become  definitely  in- 
sane, but  death  is  the  more  frequent  result. 

I  have  before  me  a  clipping  from  a  newspaper 
published  in  Columbus,  Ohio.    There,  after  the 


244         HABITS  THAT  HANDICAP 

enforcement  of  restrictive  legislation,  the  au- 
thorities found  it  necessary  to  ask  the  governor 
for  some  special  procedure  which  would  author- 
ize them  to  supply  drug  victims  with  their  drugs 
until  proper  medical  treatment  was  provided. 
This  did  not  relate  to  those  victims  who  had 
come  exclusively  from  the  under-world,  but  re- 
ferred specially  to  those  habitual  drug-users 
whose  habits  had  been  acquired  through  ilhiess. 
It  can  scarcely  be  expected  that  restrictive  legis- 
lation will  entirely  prevent  the  sale  and  use  of 
drugs  in  the  under-world  any  more  than  restric- 
tive legislation  has  been  able  to  prevent  the 
practice  of  burglary  or  any  other  type  of  crime 
or  lawlessness.  It  is  highly  probable  that  the 
under-world  will  always  be  able  to  get  its  drugs ; 
but  it  is  nevertheless  true  that  the  passage  of 
restrictive  legislation  and  the  enforcement  of 
such  laws  will  tend  to  prevent  the  descent  of 
many  into  the  criminal  class. 

Even  this  is  comparatively  unimportant. 
Those  who  suffer  most  are  those  who  have  been 
given  the  habit  by  physicians.  These  are  hon- 
est drug-users,  and  to  them  at  this  writing  no 
helping  hand  is  anywhere  held  out  save  in  New 
York  State.  I  have  been  somewhat  disgusted — 
I  am  sure  that  is  the  word  I  wish  to  use — ^by  the 


DEUGS  AND  INSANITY  245 

continual  outpouring  of  sympathy  and  constant 
manifestations  of  anxiety  on  the  part  of  good 
people  in  regard  to  the  under-world,  when  these 
same  good  people  regard  with  indiiference  or 
classify  as  criminal  the  involuntary  victim 
toward  whom  the  most  intense  and  understand- 
ing sympathy  should  be  extended. 

MENTAL  ATTITUDE   OF   THE   DEUG-TAKEE   AND 
THE   ALCOHOLIC 

The  victim  of  drugs  psychologically  differs 
very  materially  from  the  victim  of  drink.  Until 
his  trouble  has  reached  an  acute  stage,  the  alco- 
holic feels  little  interest  in  any  of  the  methods 
advertised  as  remedial  for  alcoholism.  Many 
men  deny  to  their  friends  and  even  to  them- 
selves that  they  are  alcoholics  until  they  have 
reached  a  point  akin  to  hopelessness  in  their 
friends '  eyes  and  their  own.  The  drug-user,  on 
the  other  hand,  knows  that  he  is  a  victim  as  soon 
as  he  becomes  one ;  in  ninety-nine  cases  out  of  a 
hundred  he  is  immediately  filled  with  an  intense 
longing  to  be  relieved  of  his  habit.  Thousands 
of  alcoholics  will  defend  their  vice.  A  library 
might  be  filled  with  books,  fictional  and  other, 
glorifying  alcohol  and  the  good-fellowship  and 
conviviality  that  it  is   supposed  to   promote. 


246         HABITS  THAT  HANDICAP 

One  might  search  a  long  time  for  a  victim  of 
any  drug  habit  who  would  speak  with  affection 
of  the  material  which  has  enthralled  him.  No 
poet  has  ever  written  any  song  glorifying  mor- 
phine. There  is  no  drug-user  in  the  world  who 
would  not  hail  with  joy  any  opportunity  that 
might  lead  to  his  relief.  The  drug-victim  inves- 
tigates every  hint  of  hope  with  eager  interest, 
reading,  intelligently  questioning,  experiment- 
ing. He  shrinks  from  publicity  with  a  horror 
that  is  backed  by  an  acute  consciousness  of  his 
condition,  while  the  victim  of  alcohol  becomes 
so  mentally  distorted  or  deadened  that  he  takes 
no  thought  of  consequences,  cares  nothing  for 
publicity,  and  finds  himself  unable  to  avoid  pub- 
lic exhibitions  of  a  kind  that  put  him  into  the 
hands  of  the  police.  Public  hospitals  do  not 
tempt  the  drug-user  for,  having  investigated 
them,  he  knows  that  they  are  not  competent  to 
give  him  real  relief. 

EXPEDIENTS   OF  DETJG-TAKERS 

Nothing  but  really  enforced  restrictive  le^s- 
lation,  fashioned  after  the  model  of  the  present 
New  York  State  law,  will  bring  to  light  the  drug- 
victims  in  any  community.  The  New  York  law 
uncovered  thousands  of  them,  and  within  two 


DRUaS  AND  INSANITY  247 

weeks  forced  Bellevue  and  other  Hospitals  to 
devote  many  beds  to  sufferers  from  drug-depri- 
vation. Similar  restrictive  legislation  would 
uncover  every  sufferer  from  drugs  in  the  coun- 
try and  thus  accomplish  more  good  than  could 
be  achieved  by  any  other  similarly  simple 
means.  No  man  on  earth  is  more  pitiably  af- 
fected than  the  drug-taker;  no  suffering  is  more 
intense  than  his  when  deprived  of  his  drug.  The 
fact  that  rather  than  undergo  such  suffering 
men  and  women  will  resort  to  the  most  desperate 
expedients  has  been  proved  a  thousand  times. 
When  confronted  by  the  terrible  prospect  of 
deprivation,  they  invented  plans  worthy  of  the 
mental  agility  of  the  most  famous  fictionist. 
Drugs  were  smuggled  into  prison  hidden  in 
the  heels  of  visitors '  shoes.  One  wife  who  knew 
the  agony  her  husband  must  endure  if  deprived 
of  his  regular  morphine  dosage  took  to  him 
clean  linen  which  was  admitted  to  the  prison 
without  question,  but  which,  as  an  accident  re- 
vealed, had  been  '^ starched"  with  morphine. 
Another  ingenious  wife  or  sweetheart  devised 
the  expedient  of  sending  in  to  a  prisoner 
oranges  from  which  the  juice  had  been  cleverly 
extracted  and  which  had  been  filled  hypodex'- 
mically  with  a  morphine  solution, 


248        HABITS  THAT  HANDICAP 

If  there  is  no  length  to  which  a  drug  victim 
will  not  go  rather  than  find  himself  deprived  of 
his  drug,  there  is  no  length  to  which  he  will 
not  go  in  order  to  obtain  relief  from  a  habit 
the  existence  of  which  fills  him  with  horror. 
This  has  often  been  illustrated  in  the  course  of 
my  practice,  but  perhaps  never  more  strikingly 
than  when  I  learned  of  the  experiences  of  a 
certain  judge  in  Jacksonville,  Florida.  This 
far-sighted,  merciful,  and  progressive  jurist  had 
come  in  contact  with  one  or  more  pitiable  cases 
of  the  drug  habit  to  which  he  wished  to  give  re- 
lief. He  communicated  with  me,  and  I  was  very 
glad  to  cooperate  in  aiding  with  definite  medical 
relief  several  drug-victims  taken  before  him. 
This  procedure  was  commented  upon  in  the  pub- 
lic press,  and  presently  the  judge  found  himself 
importuned  for  help  by  those  who  had  com- 
mitted no  crime,  but  expressed  themselves  as 
quite  willing  to  be  sent  to  prison  as  the  only  way 
in  which  they  could  get  the  treatment  that  was 
being  administered  under  his  auspices. 

DRUG-TAKING  MORE   OFTEN"  THE   CAUSE   THAN   THE 
RESULT   OF   CRIMINALITY 

A  careful  study  of  the  histories  of  drug-takers 
who  upon  one  charge  or  another  find  themselves 


DRUGS  AND  INSANITY,  249 

cauglit  in  the  meshes  of  the  law  will  reveal  that 
in  most  cases,  or  at  least  in  many  cases,  the  drug 
habit  has  led  to  crime  rather  than  the  reverse. 
If  an  efficient  treatment  for  the  drug  habit  were 
established  in  a  prison  almost  anywhere  in  the 
United  States  where  such  a  treatment  did  not 
elsewhere  exist,  it  would  result,  I  am  sure,  in 
the  actual  commission  of  crimes  by  a  certain 
number  of  people  willing  to  endure  the  misery 
and  disgrace  of  incarceration  for  the  mere  sake 
of  securing  treatment  for  thsir  affliction.  Any 
drug-user  will  tell  you  that  no  punishment  re- 
corded in  the  course  of  human  history,  no  tor- 
ture visualized  by  the  most  inventive  imagina- 
tion, can  compare  with  the  unspeakable  agony 
of  deprivation. 

FALLACY   OF   IMPRISONING  DEUG-TAKEES 

That  imprisonment  should  rarely,  if  ever,  re- 
sult in  freeing  a  person  from  the  drug  habit  can 
mean  only  one  thing:  that  drugs  are  obtainable 
in  every  prison.  Guards  and  other  employees 
in  such  institutions  are  of  a  low  class,  for  men 
and  women  of  a  high  type  are  unlikely  to  seek 
such  employment.  I  fear  that  this  fact  will 
prove  one  of  the  most  serious  stumbling-blocks 
in  the  path  of  those  who  are  endeavoring  to 


250         HABITS  THAT  HANDICAP 

make  a  success  of  inebriety-farm  experiments. 
In  the  first  place,  tliey  will  not  be  able  to  find 
men  of  a  high  type  anxious  to  serve  in  the  sub- 
ordinate positions  provided  at  such  places ;  and 
in  the  second  place,  even  if  such  men  can  be 
found,  they  will  be  unlikely  to  obtain  positions 
because  persons  of  an  inferior  type  will  be  cer- 
tain to  be  pushed  forward  by  political  influence. 
Such  places  would  be  used  as  means  wherewith 
to  pay  political  debts,  and  this  would  be  more  or 
less  complacently  tolerated,  because  society  has 
always  underrated  and  still  underrates  the  ter- 
rific complications  of  the  task  of  working  for 
the  reclamation  of,  or  even  caring  for,  the  down- 
and-out.  Such  work  is  not  employment  for  the 
saloon-keeper,  the  ward  heeler,  or  the  ex-prize- 
fighter, and  of  such  is  the  personnel  of  most 
prison  staffs  made  up.  The  reclamation  of  the 
alcoholic  wreck  means  far  more  than  physical 
rehabilitation.  It  means  moral  and  psycholog- 
ical regeneration,  and  such  work  can  be  done 
only  by  people  of  understanding  and  delicate 
sensibility.  The  alcoholic  from  the  city  who 
has  been  perhaps  an  office  employee  or  a  pro- 
fessional man  and  who  is  sent  to  an  inebriate 
farm  will  find  there  nothing  curative  save  depri- 
vation.   Even  if  outdoor  work  will  harden  his 


DRUGS  AND  INSANITY  251 

muscles,  it  must  be  admitted  that  the  surround- 
ings in  whicli  this  is  accomplished  may  well 
ossify  his  brain. 

PSYCHOLOGY  OP  THE  DEUG  HABIT 

Nothing  could  more  clearly  indicate  the  popu- 
lar ignorance  concerning  the  drug  habit  than 
the  general  belief  that  it  is  usually  accompanied 
by  moral  deterioration.  Where  the  habit  is  an 
accompaniment  of  life  in  the  under-world,  moral 
deterioration  of  course  exists,  though  this  is  due 
rather  to  the  under-world  than  to  the  drug 
habit.  In  the  thousands  of  histories  where  the 
habit  has  been  acquired  by  the  administration  of 
drugs  by  physicians  it  results  in  moral  deterio- 
ration no  more  than  drinking  tea  does.  As  a 
matter  of  fact,  that  portion  of  society  which 
holds  a  drug  victim  blamable  is  woefully  mis- 
taken and  inhumanely  unmerciful,  the  truth 
being  that  the  man  or  woman  who  is  not  taking 
drugs  is  lucky. 

THE   NECESSITY   OF  DEFINITE   MEDICAL  TREATMENT 
IN   DEALING  WITH   ANY   FORM   OF   ADDICTION 

It  is  impossible  for  me  to  conclude  this  book 
without  discussing  further  the  question  of  treat- 
ment for  those  afflicted  with  habits  or  addictions, 


252        HABITS  THAT  HANDICAP 

My  taking  up  tliis  work  in  1901  was  due  al- 
most entirely  to  an  investigation  into  the  meth- 
ods employed  to  restore  those  who  had  lost  con- 
trol through  the  use  of  habit-forming  drugs, 
whether  they  had  acquired  the  habit  through 
dissipation  or  from  the  administration  of  the 
drug  by  a  physician  on  account  of  illness  or  in- 
jury. At  that  time  such  cases  were  supposed  to 
be  hopelessly  incurable,  and  the  victims  only 
drifted  from  bad  to  worse  until  they  had  been 
accounted  for  either  in  a  mad-house  or  in  the 
morgue. 

I  found,  on  making  inquiries  from  some  of  the 
leading  medical  men  who  had  been  dealing  with 
the  various  types  of  mental  and  nervous  dis- 
eases, that  they  were  virtually  unable  to  name 
any  case  of  a  confirmed  drug-user  who  had  been 
permanently  benefited  by  institutional  or  any 
other  means  of  treatment.  This  was  very  diffi- 
cult to  understand,  particularly  in  the  case  of 
drug-users  who  had  acquired  the  habit  through 
the  administration  of  the  drug  by  a  physician, 
and  who  earnestly  desired  to  be  freed  from  the 
habit.  It  seemed  incredible  that  a  skilled  phy- 
sician could  not  eliminate  the  craving  or  desire 
for  the  drug,  or  restore  these  unfortunates  to 


DEUGS  AND  INSANITY  253 

the  point  where  their  systems  would  not  demand 
or  feel  the  need  of  it. 

I  soon  found  out  why  this  was  so.  My  inves- 
tigation showed  me  that  the  drug  habit  is  a  men- 
tal as  well  as  a  physical  condition ;  that  the  phy- 
siological action  of  an  opiate  is  to  tie  up  the 
functions,  resulting  in  a  deterioration  of  the 
vital  organs  when  the  victim  has  taken  the  drug 
sufficiently  long  to  set  up  a  definite  tolerance. 

The  medical  world  had  apparently  been  un- 
able or  had  not  attempted  to  bring  about  a  defi- 
nite physiological  change,  and  to  place  such 
patients  where  they  would  not  crave  drugs  and 
where  their  systems  would  not  demand  them. 
To  my  further  surprise,  I  found  that  the  medi- 
cal world  had  been  depending  entirely  on  depri- 
vation as  a  means  of  treating  such  cases.  They 
would  immediately  send  patients  to  an  institu- 
tion where  they  were  put  under  surveillance  and 
guarded  by  attendants,  or  they  would  attempt 
by  gradual  reduction  of  the  dosage  to  eliminate 
the  habit. 

CIJEE   BY  DEPEIVATION  IMPOSSIBLE 

This  investigation  led  me  into  some  very  in- 
teresting discoveries.    I  found  that  old,  con- 


254        HABITS  THAT  HANDICAP 

firmed  subjects  of  tlie  drug  liabit  were  sent  to 
such  institutions.  Wliere  they  were  taking 
large  daily  doses  of  opiates  the  institutions  were 
able  to  reduce  these  people,  when  there  was  no 
underlying  physical  disability,  within  a  few 
weeks  or  a  few  months,  according  to  the  tem- 
perament of  the  patient,  to  a  very  small  daily 
dosage,  often  as  low  as  one  half  or  one  eighth 
of  a  grain  a  day.  When  they  had  reached  this 
dosage  it  was  often  found  absolutely  impossible 
to  limit  them  further.  In  some  cases  where  the 
patient  was  confined  and  finally  deprived  of  the 
drug  entirely  I  found  that  when  he  had  reached 
this  minimum  dosage  he  would  suffer  just  as 
much  physical  discomfort  in  the  end  as  if  he 
had  been  suddenly  deprived  of  a  very  much 
larger  quantity  of  the  drug  taken  daily.  This 
led  up  to  the  further  interesting  fact  that  even 
where  patients  were  finally  deprived  of  the  drug 
and  Hved  through  the  horrible  suffering  inevi- 
tably accompanying  the  deprivation,  although 
they  outlived  the  tremendous  depression  and 
lassitude  which  followed,  and  for  long  periods 
of  weeks  and  months  after  that  time  had  the  best 
of  care  and  attention  until  they  showed  marked 
improvement  in  their  physical  condition,  never- 


DRUGS  AND  INSANITY  255 

theless,  with  too  few  exceptions,  they  never  lost 
the  desire  for  the  drug.  Always  the  need  of 
some  stimulant  returned,  and  on  the  slightest 
excuse  or  opportunity  they  were  taking  their 
drug  again.  My  investigation  finally  proved  to 
me  that  deprivation  did  not  remove  the  cause  of 
the  drug  habit,  because  it  did  not  remove  the 
physical  craving  for  the  drug.  No  matter  how 
long  a  period  the  deprivation  had  been,  the 
needed  physical  and  mental  change  had  never 
taken  place. 

EFFICACY   OF   THE   AUTHOE's   TEEATMENT 

During  the  first  two  years  of  my  work,  after 
finding  in  various  ways  patients  from  the  under- 
world to  use  as  subjects  for  demonstration,  I 
was  finally  able  to  treat  any  case  of  drug  habit 
which  came  to  me  unless  it  was  complicated  by 
underlying  physical  disability.  After  a  period 
of  from  three  to  four  days  these  patients  would 
not  feel  the  slightest  craving  or  desire  for  any 
form  of  opiate,  whether  their  addiction  had  been 
cocaine,  alcoholic  stimulants,  or  tobacco. 

When  the  ejEficacy  of  this  treatment  was  as- 
sured, it  began  to  attract  the  attention  of  some 
of  the  best-known  medical  men  in  the  country — 


256        HABITS  THAT  HANDICAP 

men  who  were  interested  in  this  line  of  study. 
They  followed  carefuUy  the  medical  administra- 
tion of  the  new  treatment  of  these  cases. 

It  was  only  a  matter  of  time  before  the  value 
of  the  work  was  thoroughly  established  and  be- 
came a  medical  fact.  After  hundreds  of  definite 
clinical  histories  had  been  recorded,  the  formula 
was  publicly  announced,  first,  at  the  Interna- 
tional Opium  Conference  at  Shanghai  in  1909, 
and  a  month  later  to  the  medical  world.  Since 
the  complete  information  concerning  my  work 
has  been  given  to  the  medical  profession,  and 
after  all  these  years  of  study  and  investigation 
and  medical  comment,  I  have  never  yet  had  from 
any  physician  an  entirely  satisfactory  explana- 
tion as  to  why  or  how  we  were  able  successfully 
to  unpoison  these  cases  in  this  short  period. 
At  present  this  treatment  is,  so  far  as  I  know, 
the  only  one  known  to  medical  science  that  will 
bring  about  this  definite  physiological  change. 

The  intelligent  beginning  of  help  in  these 
cases  is  to  unpoison  the  patient,  put  him  physi- 
cally on  his  feet,  where  he  does  not  want  drugs 
or  drink,  and  where  he  does  not  feel  the  slight- 
est desire  or  craving  for  them,  and  has  no  dread 
of  ever  drifting  into  these  habits  again.  "When 
you  have  brought  about  this  definite  physical 


DEUGS  AND  INSANITY  257 

change,  you  are  invariably  able  to  get  a  definite 
mental  change.  You  cannot  hope  to  get  the 
mental  change  until  you  have  first  cleared  the 
system  of  poison,  for  in  this  state  the  patient  is 
in  a  most  responsive  condition  to  deal  with. 
If  physical  building  up,  change  of  environment, 
change  of  surroundings  in  any  way  whatever  are 
necessary,  they  can  then  be  taken  up  intelli- 
gently. 

LEGISLATIVE   EFFOETS 

The  knowledge  I  gained  from  dealing  medi- 
cally with  those  afflicted  with  habits  and  addic- 
tions led  me  to  take  up  personally  the  movement 
to  bring  about  definite  legislation  with  a  view 
to  subordinating  as  much  as  possible  the  traffic 
and  consumption  of  drugs  to  legitimate  medical 
needs ;  and  to  put  an  end  to  the  criminal  negli- 
gence by  which  such  drugs  have  been  permitted 
to  be  imported,  manufactured,  and  distributed. 

In  contact  with  the  afflicted  of  this  class,  I  dis- 
covered the  laxity  with  which  drugs  were  dealt 
in,  and  began  in  1912  to  try  and  bring  about 
some  restrictive  legislation  with  regard  to  the 
evil  before  the  New  York  legislature.  I  had 
first  found  that  in  the  medical  use  of  the  drug 
the  principal  evil  had  sprung  from  the  knowl- 


258        HABITS  THAT  HANDICAP 

edge  of  what  would  ease  pain,  and  that  the  prin- 
cipal means  used  for  this  purpose  was  the  hypo- 
dermic syringe.  At  that  time  there  was  no 
restriction  placed  upon  the  sale  of  this  instru- 
ment ;  it  could  be  bought  in  any  drug  store  just 
as  easily  as  a  package  of  chewing-gum.  The 
department  stores  that  carried  drug  supplies 
advertised  hypodermic  outfits  as  low  as  twenty- 
five  cents.  A  physician's  instrument  permitted 
to  be  manufactured  and  sold  in  this  way! 
Through  the  bill  which  was  introduced  in  the 
New  York  legislature  in  1912,  for  the  first  time 
in  the  history  of  the  medical  world  it  became 
possible  to  purchase  this  instrument  only  on  a 
physician's  prescription. 

In  1913  I  was  the  author  of  a  drastic  law  regu- 
lating the  sale  of  habit-forming  drugs  in  New 
York  State,  but  because  of  severe  pressure 
brought  by  physicians  and  druggists,  I  was  un- 
able to  put  it  through.  In  1914  I  tried  again, 
and  after  a  hard  fight  I  was  able  to  have  enacted 
a  bill,  which  was  introduced  by  Senator  John  J. 
Boylan,  and  which  bears  his  name.  For  the 
first  time  there  was  put  upon  the  statute-books 
of  a  State  real  restrictive  drug  legislation. 
Other  States  are  taking  up  this  matter,  and,  as 
the  intention  was,  the  New  York  bill  has  been 


DRUaS  AND  INSANITY  259 

the  means  of  establishing  a  legislative  prece- 
dent. 

I  regret  very  much  that  the  aim  and  purpose 
of  Federal  legislation  has  been  largely  defeated 
by  the  powerful  drug  interests,  but  I  predict  that 
it  is  only  a  matter  of  time  before  public  senti- 
ment will  defeat  this  powerful  drug  lobby,  as 
it  has  always  defeated  other  lobbies  of  a  simi- 
lar kind,  and  that  the  country  will  be  largely 
freed  from  the  illegal  habit-forming  drug  traf- 
fic. 

Until  there  is  some  international  understand- 
ing between  the  countries  that  produce  these 
drugs  and  the  countries  that  consume  them,  we 
shall  have  to  submit  to  more  or  less  smuggling 
of  these  drugs  into  our  country.  Smuggled 
goods  rarely,  if  ever,  find  their  way  into  chan- 
nels for  legitimate  medical  needs,  and  for  that 
reason  it  is  only  the  under-world  that  would  be 
affected  by  their  use  and  abuse. 

It  is  only  a  matter  of  time  before  the  commis- 
sioners of  health  for  the  various  States  will  be 
given  authority  enabling  them  to  issue  rules  and 
regulations  governing  the  health  of  the  people 
that  will  wipe  out  the  quacks  and  charlatan 
venders  of  all  common  advertised  fake  medicine 
cures. 


260        HABITS  THAT  HANDICAP 

THE    NEED   FOE   REGULATING   THE   ADMINISTEATlOlir 
or   DRUGS 

I  have  Ibeen  told  that  to  require  a  consultation 
of  physicians  before  the  administration  of  a 
habit-forming  drug  would  put  upon  the  patient 
a  financial  burden  which  he  should  not  be  asked 
to  bear.  No  fallacy  could  be  more  complete. 
There  is  in  the  United  States  to-day  not  one 
victim  of  the  drug  habit  who,  knowing  as  he  does 
the  intense  suffering  it  entails,  would  not  rather 
have  given  up  ten  years  of  his  life  and  been 
forced  to  put  a  mortgage  on  his  soul  than  to 
have  had  this  habit  fastened  on  him.  Money? 
Money  is  nothing!  The  cost  of  a  consultation 
is  a  small  price  to  pay  for  the  possible  difference 
between  life-long  thralldom  and  free  manhood 
or  womanhood.  And  let  me  add  in  regard  to 
the  physician  who  objects  to  the  legal  establish- 
ment of  a  danger-point  in  drug  administration 
that  the  physician  who  feels  big  enough  to  accept 
personally  the  responsibility  of  creating  a  drug 
habit  is  too  small  to  be  intrusted  with  that 
power. 


DRUGS  AND  INSANITY  261 

PERCENTAGE  OF  THOSE  TO  WHOM  THE  PEEMANENT 
ADMINISTRATION  OP  DRUGS  IS  A  NECESSITY 

The  percentage  of  sick  people  to  whom  the  ad- 
ministration of  habit-forming  drugs  is  a  neces- 
sity for  the  preservation  of  life  or  comfort  is 
smaller  than  is  generally  supposed  even  by  the 
medical  profession.  When  I  was  drafting  my 
restrictive  bill  to  be  introduced  into  the  New 
York  legislature,  I  was  asked  by  my  lawyer  to 
enumerate  those  physical  troubles  which  de- 
manded the  constant  use  of  habit-forming  drugs. 
I  found  this  to  be  impossible.  I  have  known 
many  instances  in  which  to  deprive  of  drugs 
patients  suffering  incurable  illness  would  have 
been  little  less  than  criminal.  This  alone  en- 
abled them  to  live  in  comparative  comfort. 

I  have  known  of  many  cases  of  drug  habit 
which  have  grown  out  of  the  administration  of 
morphine  for  recurring  troubles,  such  as  renal 
colic.  Such  a  disorder  as  this,  however,  should 
never  give  rise  to  a  drug  habit,  because  those" 
suffering  from  it  are  subject  to  such  brief  peri- 
ods of  pain  that  a  physician  could  administer 
the  necessary  drug  without  their  knowledge.  I 
have  had  many  cases  of  women  who,  acquiring 
the  habit  through  the  administration  of  drugs 


262        HABITS  THAT  HANDICAP 

at  tlie  time  of  their  montlily  periods,  became  Ha- 
bitual users,  although  each  recurrence  of  the 
pain  lasted  only  three  or  four  days.  When  this 
problem  is  thoroughly  understood,  such  cases 
will  be  impossible,  for  legislation  will  not  only 
prevent  the  layman  from  securing  habit-forming 
drugs,  but  will  prevent  the  doctor  from  the  in- 
discriminate administration  of  them. 

Of  course  the  general  reader  may  think  this 
book  merely  a  clever  advertisement.  In  it  I 
state  that  it  is  wrong  to  stop  the  use  of  morphine 
and  alcohol  unless  the  victims  can  be  treated  for 
the  habit,  and  next  I  condemn  doctors  and  sana- 
toriums  for  their  useless  methods  of  treatment, 
while  lauding  my  own.  Naturally,  my  reader 
may  assume  that  my  only  motive  is  the  selfish 
one  of  money. 

Well,  one  may  suppose  what  he  likes,  but  the 
truth  is  that  I  urge  every  city  and  State  to  estab- 
lish places  that  will  drive  me  out  of  business.  I 
urge  physicians  to  take  up  this  treatment  and 
cure  their  own  colleagues.  I  have  no  secrets. 
My  methods  have  been  published,  and  I  am  now 
devoting  most  of  my  time  to  legislative  work 
from  which  I  do  not  profit  a  cent. 


APPENDIX 


THE  EELATION  OF  ALCOHOL 
TO  DISEASE 


ALEXANDER  LAMBERT,  M.D. 
Visiting  Physician  to  Bellevue  Hospital;  Professor  of  Clinical 
Medicine,  Cornell  University- 
Author  of  "Hope  for  the  Victims  of  Narcotics" 

IN  the  simple  heading  of  the  subject-matter 
of  this  article  there  are  contained  such  pos- 
sibilities of  facts  and  fancies,  truths  and  errors, 
and  wide  differences  of  opinion,  that  it  seems 
wise  to  define  not  only  its  meaning,  but  some  of 
the  words  themselves.  What  is  disease?  To 
many  people  it  is  a  definite,  concrete  thing  which 
seizes  one  in  its  clutches,  holds  one  captive  or 
possesses  one  for  a  second  time,  and  then  if  over- 
come releases  its  grip  and  one  is  free  and  in  good 
health  again.  But  disease  is  not  an  entity,  even 
though  some  agents,  as  bacteria,  are  living  or- 
ganisms. It  is  the  lack  of  some  processes  which 
these  agents  overcome,  and  others  which  they 
set  in  motion,  as  manifested  by  disturbances  of 

265 


266  APPENDIX 

various  functions  of  different  organs  in  the 
body  that  make  up  some  of  our  diseases.  Our 
bodies  are  often  in  a  state  of  delicate  equilib- 
rium, and  if  some  one  gland  fails  to  secrete,  or 
secretes  too  abundantly,  the  resulting  condition 
may  become  a  disease.  As  health  is  a  harmoni- 
ous relationship  between  the  various  functions 
of  different  parts  of  the  body,  so  disease  is  a  dis- 
turbance of  this  harmony.  The  question  of  the 
relation  of  alcohol  to  disease  becomes  a  question 
as  to  whether  or  not  this  narcotic  if  taken  into 
the  body  can  react  on  the  various  tissues  and 
organs  of  the  body  to  such  a  degree  as  to  disturb 
the  equilibrium  of  health.  And,  furthermore, 
can  this  disturbance  of  healthy  equilibrium  be 
permanent  and  the  body  acquire  a  lasting  dis- 
eased condition? 

HOW   IT   AFTECTS   DIFFEEENT   MEN 

Alcohol  is  classed  here  as  a  narcotic  and  not 
a  stimulant,  because  we  shall  see  later  that  alco- 
hol is  rather  a  paralyzer  of  functions,  even  when 
it  seems  to  stimulate,  than  a  producer  of  in- 
creased output  from  any  organ.  The  time  hon- 
ored idea  that  alcohol  is  a  stimulant  and  that,  if 
used  in  moderation,  it  is  a  tonic,  is  so  ingrained 
in  the  average  mind  that  it  is  with  the  greatest 


APPENDIX  267 

difficulty  tliat  men  can  be  made  to  realize  tliat 
even  in  what  seems  moderate  doses  it  may  in- 
jure them.  This  is  especially  true  as  one  sees 
men  who  all  their  lives  have  indulged  moder- 
ately in  alcoholic  beverages  from  which  seem- 
ingly no  harm  has  resulted.  The  truth,  per- 
haps, is  best  summed  up  by  the  old  adage  that 
what  is  one  man's  meat  is  another  man's  poison, 
and  there  is  no  question  that  the  effects  of  alco- 
hol in  small  or  moderate  doses  is  vastly  different 
from  its  effects  in  large  doses,  or  in  long  contin- 
ued, excessive  use.  Different  human  beings  re- 
act differently  to  similar  amounts  of  alcohol, 
and  conversely,  identical  amounts  of  alcohol  will 
affect  different  individuals  in  different  ways, 
even  when  it  poisons  all  of  them.  For  instance, 
if  alcohol  sets  different  processes  in  motion 
which  bring  about  damage  to  the  individual,  we 
find  that  in  some  persons  it  has  injured  the  heart 
and  arteries,  in  others  it  has  affected  the  liver  or 
stomach,  leaving  the  brain  and  nervous  tissues 
free  from  damage,  while  in  still  others  the  body 
in  general  seems  to  be  untouched  and  the  brain 
and  nervous  tissues  suffer  the  injuries.  It  is 
not  uncommon  to  see  a  man  who  has  partaken 
freely  of  alcoholic  beverages  all  his  Kfe  with 
neither  he  nor  his  friends  conscious  that  his 


268  APPENDIX 

intellect  has  suffered  or  deteriorated  thereby,  to 
find  suddenly  that  his  circulatory  and  digestive 
systems  are  seriously  and  permanently  dam- 
aged. On  the  other  hand,  many  a  drunkard  has 
become  a  burden  to  his  family  and  the  commu- 
nity, with  his  personality  deteriorated,  his  intel- 
lect rendered  useless,  while  his  circulation  and 
digestion  remain  unimpaired,  and  he  lives  long 
years  a  nuisance  and  a  burden  to  his  environ- 
ment. 

Since  I  have  made  the  distinction  between 
moderation  and  excess  in  the  use  of  alcohol,  it 
will  be  well  to  define  what  is  regarded  as  excess, 
and  what  moderation,  in  order  that  the  effects 
of  both  may  be  considered.  Physiologic  excess, 
it  seems  to  me,  has  been  best  defined  by  a  bril- 
liant Frenchman  named  Duclaux,  who  says  that 
any  one  has  drunken  alcohol  to  excess  who  one 
hour  after  he  has  taken  it  is  conscious  in  any 
way  of  having  done  so.  If  after  a  drink  of  any 
alcoholic  beverage  has  been  taken,  wine,  whis- 
key, or  whatever  it  may  be,  an  hour  later  we  feel 
ourselves  flushed,  tongue  loosened,  or  if  we  are 
heavy  and  drowsy,  or,  if  we  find  our  natural  re- 
serve slightly  in  abeyance,  if  the  judgment  is  not 
as  sternly  accurate  as  before  partaking  of  the 
beverage,  if  the  imagination  is  unusually  active 


APPENDIX  269 

and  close  consecutive  reasoning  not  as  easy  as 
before,  if  we  think  we  do  our  work  much  better, 
but  next  morning  realize  we  haven't  accom- 
plished quite  as  much  or  done  it  as  well  as  we  ex- 
pected, then  we  have  shown  a  physiologic  exces- 
sive intake  of  alcohol,  and  an  amount  which  if 
continued  will  produce  damage  somewhere  in 
the  body.  Moderation  in  the  use  of  alcohol 
means  that  it  be  taken  in  amounts  of  which  one 
remains  unconscious.  This  may  seem  a  narrow 
and  hard  line  to  draw,  and  may  seem  to  confine 
the  amount  of  alcohol  that  may  be  consumed  to 
much  less  than  many  people  wish  to  indulge  in. 
How  much  in  actual  amount  this  should  be  with 
any  given  individual  depends  upon  that  indi- 
vidual alone,  and  no  one  can  be  a  law  to  any 
other  individual  than  himself.  If  a  man  be  en- 
gaged in  severe  manual  labor  or  muscular  exer- 
cise, he  can  consume  more  alcohol  without 
detriment  than  when  leading  a  sedentary  life, 
although  the  character  of  the  work  that  he  will 
do  may  not  be  as  good  as  if  no  alcohol  were 
taken. 

THE   MODERATE   "USE   OP   ALCOHOL 

The  above  definition,  however,  must  suffice. 
We  must  fix  some  standard  between  moderation 


270  APPENDIX 

and  excess,  and  the  more  accurately  we  define 
moderation,  the  more  narrowly  do  we  confine  it. 
Judge  by  the  above  standard,  alcohol  taken  in 
moderate  doses  does  not  seem  more  than  to  stim- 
ulate the  digestive  processes  of  the  stomach,  in- 
crease the  flow  of  blood  through  the  heart,  in- 
crease the  circulation  in  the  periphery  and  skin, 
dilate  the  capillaries,  and  make  it  easier  for  the 
circulation  to  complete  its  cycles.  When  ab- 
sorbed into  the  body  in  such  doses,  it  can  act  as 
a  food,  and,  in  fact,  as  much  as  is  burnt  up  by 
the  body  does  act  as  a  food,  although  it  differs 
from  other  foods  in  that  it  is  never  stored  up. 
It  can  replace  in  energy-giving  properties  su- 
gars or  fats,  and  being  burnt  up  by  the  body  can 
give  out  the  equivalent  of  sugar  and  fat  in  mus- 
cular energy,  and  heat  generated  and  given  out 
by  the  body.  Its  effect  is  similar  to  that  ob- 
tained by  sugar  and  fats  which  are  taken  up  by 
the  body  when  needed  and  in  the  amounts 
requisite  to  the  body  at  the  moment,  and  it  seems 
to  be  treated  as  far  as  can  be  seen  as  other  foods 
for  fuel.  But  it  is  not  an  economical  fuel  be- 
cause the  human  organism  does  not  perform  its 
work  as  well  as  when  there  is  no  alcohol  in  the 
ration.  Simultaneously  when  being  consumed 
as  food  it  is  exerting  its  drug  action.    In  this 


APPENDIX  271 

process  it  is  tlie  more  easily  available,  and  thus 
the  sugar  and  fats  are  stored  up  while  the  alco- 
hol is  burnt  up ;  it  spares  the  fat  consumption, 
often  causing  an  increase  of  bodily  weight 
through  the  putting  on  of  fat.  To  those  who 
are  accustomed  to  its  use,  it  seems  also  to  spare 
the  protein  consumption  of  the  body,  but  to 
those  unaccustomed  to  its  use  it  has  the  opposite 
effect,  increasing  the  destructive  breaking  down 
of  proteins. 

DANGER   SIGNALS   UNHEEDED 

Moderate  indulgence  in  alcoholic  beverages 
adds  to  the  pleasures  of  existence  with  a  great 
many  men,  and  while  it  seems  to  increase  their 
pleasures  and  broaden  the  extent  of  their  mental 
experiences,  it  cannot  be  said  to  increase  their 
powers  of  accurate  mental  activity,  though  it 
temporarily  increases  the  imaginative  flow  of 
ideas.  It  relieves  the  feeling  of  both  body  and 
mental  fatigue  for  the  time  being,  an  effect  which 
may  be  an  advantage  or  may  be  a  distinct  disad- 
vantage, for  fatigue  is  Nature's  warning  when 
to  stop,  and  if  we  dull  ourselves  to  this  feeling 
and  leave  the  warning  unheeded,  we  may  easily 
go  on  to  harmful  excesses  of  overwork  and  over- 
exertion.   It  is  doubtful  if  the  moderate  drink- 


272  APPENDIX 

ing  of  alcohol,  as  we  have  defined  moderation, 
sets  in  motion  processes  wMch  may  so  disturb 
the  equilibrium  of  the  body  as  to  cause  disease. 
Broadly  speaking,  the  excessive  use  of  alcohol 
injures  the  body  in  two  ways.  It  injures  the 
functional  cells  of  the  different  organs  for  alco- 
hol is  distinctly  a  cellular  poison,  and  it  further 
disturbs  the  nutrition  of  the  organs  by  its  in- 
jurious action  on  the  blood  vessels  which  supply 
nutrition  to  the  various  parts  of  the  body. 
Whether  to  replace  the  destroyed  cells  or  as  a 
result  of  the  congestion  there  is  also  an  increase 
in  the  connective  tissue  framework  of  the  vari- 
ous organs.  The  action  of  alcohol  on  the  circu- 
lation is  one  of  the  earliest  effects  which  is 
shown  after  it  is  taken  into  the  body.  The  flush- 
ing of  the  skin  is  a  beginning  paralysis  of  the 
minute  capillary  blood  vessels.  If  habitually 
indulged  in,  the  effect  is  a  continuous  dilatation 
of  the  vessels,  although  it  seems  for  a  while  in 
the  early  stages  that  there  is  a  toning  up  of  the 
circulation.  Yet  excessive  indulgence  brings 
with  it  always  a  lowering  of  the  blood  pressure 
and  finally  the  chronic  congestions  in  the  inter- 
nal viscera.  The  action  of  the  heart  at  first  is  to 
make  it  beat  fuller  and  stronger,  but  if  con- 
tinued, the  effect  is  also  one  of  paralysis  of  its 


APPENDIX  273 

muscle  and  a  diminution  of  the  output  of  work 
done,  and  finally  it  is  a  paralyzer  of  the  heart's 
action.  In  some  persons,  through  its  injury  to 
the  cardiac  blood  vessels  and  intrinsic  muscle 
of  the  heart,  it  sets  in  motion  those  morbid 
processes  which  result  in  angina  pectoris. 

Beginning  with  the  stomach,  we  find  that  when 
alcohol  is  taken  in  excess  it  not  only  disturbs 
the  processes  of  digestion  that  are  then  going 
on,  if  it  is  taken  in  greater  amount  than  five  per 
cent,  of  the  stomach  content,  but  it  also  acts  di- 
rectly on  the  mucous  membrane,  producing  an 
irritant  action.  We  have  formed  here  a  chronic 
congestion  of  the  mucous  membrane  which  pro- 
duces swollen  cells,  and  the  digestive  glands  of 
the  stomach  produce  an  excess  of  mucus  which 
interferes  with  digestion,  and  the  resulting  con- 
gestion interferes  with  the  gastric  secretions. 
It  ends  in  producing  a  swollen,  inflamed  mucous 
membrane,  often  with  hemorrhages.  These 
processes  may  go  on  to  an  atrophic  form  of 
gastritis,  in  which  the  mucous  membrane  may  be 
so  atrophied  that  it  is  unable  to  secret  sufficient 
gastric  juice.  The  acid  of  the  gastric  juice, 
combining  with  certain  substances  in  the  intes- 
tine, is  one  of  the  stimulants  which  causes  the 
production  of  the  pancreatic  secretion.    The 


274  APPENDIX 

pancreas  not  alone  digests  tlie  meats  and  other 
proteids,  but  it  changes  starch  into  sugar,  and 
also  has  a  fat  splitting  ferment.  Thus  we  see 
that  pancreatic  digestion  is  a  most  important 
function,  and  does  much  more  in  the  digestive 
work  than  the  stomach.  When  therefore  the 
acids  of  the  gastric  juice  are  lacking,  there  is  an 
insufficient  stimulus  to  the  pancreas  to  pour  out 
its  complex  juices  and  complete  digestion. 

THE   ATTACK   UPON   THE   LIVER 

Alcohol  is  so  rapidly  absorbed  from  the  stom- 
ach and  the  upper  intestine,  that  it  does  not  as  a 
rule  produce  much  change  in  the  small  intes- 
tines. The  absorption  of  the  digested  food  from 
the  intestinal  tract  by  alcoholics  when  recover- 
ing from  a  debauch  is  greater  than  normal,  pro- 
vided they  have  ceased  from  their  alcohol.  The 
absorbing  powers  of  the  intestine  remain  a  long 
time,  and  is  the  reason  that  so  many  alcoholics 
appear  so  well  nourished.  The  acids  of  the  gas- 
tric juice  also  stimulate  the  excretion  of  bile 
from  the  liver,  and  combining  with  the  same  fer- 
ment, the  secretion,  being  taken  up  by  the  blood, 
stimulates  the  liver  to  an  increased  secretion  of 
bile.  If  therefore  one  has  so  injured  the  stom- 
ach with  the  taking  of  alcohol  that  the  mucous 


APPENDIX  275 

membrane  is  unable  to  secrete  a  proper  gastric 
juice,  it  is  readily  seen  that  the  proper  stimula- 
tion to  the  liver  and  the  pancreas  are  lacking, 
and  the  equilibrium  of  the  entire  digestive  pro- 
cess of  the  body  is  upset.  The  blood  from  all 
the  intestines  goes  directly  to  the  liver,  the  cir- 
culation of  this  organ  being  so  arranged  that  the 
blood  must  filter  through  and  bathe  the  liver 
cells  before  it  is  gathered  into  a  central  vein  and 
returns  into  the  general  circulation.  In  fact  the 
liver  is  the  great  chemical  laboratory  of  the 
body,  and  the  complex  processes  that  go  on  there 
are  as  yet  but  little  understood.  The  processes 
which  I  have  described  as  generally  characteris- 
tic of  alcohol  are  seen  to  a  very  marked  extent 
in  the  liver.  There  is  a  chronic  congestion,  and 
there  is  very  frequently  various  forms  of  degen- 
eration in  the  hepatic  cells,  and  in  many  cases 
an  increase  in  the  connective  tissue  to  such  an 
extent  as  to  cause  the  disease  known  as  cirrhosis 
of  the  liver. 

Alcohol  may  also  under  certain  circumstances 
produce  such  excessive  fatty  degeneration  in  the 
liver,  as  in  itself  to  be  a  menace  to  existence,  for 
if  the  liver  ceases  to  do  its  proper  work,  the 
whole  minute  nutritive  chemistry,  the  metabol- 
ism of  the  body,  breaks  to  pieces.    The  liver 


276  APPENDIX 

stands  an  enormous  amount  of  use  and  abuse, 
and  it  is  one  of  the  last  organs  to  give  way  under 
great  strain,  but  when  its  functional  processes 
do  break  down,  the  existence  of  the  individual 
is  not  much  further  prolonged.  The  liver  can 
consume  and  break  down  a  certain  amount  of  al- 
cohol, but  when  more  is  poured  into  it  than  it  can 
assimilate,  some  of  it  must  go  through  into  the 
general  circulation  and  over  the  body,  flowing 
to  the  brain  and  poisoning  this  organ,  and  the 
other  nervous  tissues. 

The  action  of  alcohol  on  the  nervous  tissues 
constitutes,  in  the  eyes  of  the  majority,  the  main 
injury  that  alcohol  does  to  a  human  being. 
Certain  it  is  that  the  action  of  alcohol  on  the 
brain  does  more  to  distort  and  pervert  a  man's 
relationship  with  his  environment  than  any 
other  action  which  alcohol  has  on  the  body.  It 
is  through  the  poison  of  this  organ  that  the  per- 
sonality of  the  individual  is  so  changed  and  so 
poisoned  that  a  degeneration  of  the  individual  in 
character  and  morals  is  brought  about.  It  is 
here,  too,  that  the  widest  differences  of  tolerance 
and  intolerance  to  alcohol  are  shown.  Some 
men  may  consume  enormous  quantities  and  their 
mental  balance  apparently  remain  intact. 
Other  individuals  cannot  take  a  single  glass  of 


APPENDIX  277 

wine  without  being  distinctly  affected  by  it,  or 
rendered  unmistakably  drunken.  The  gross 
injuries  found  in  the  brain  of  those  dying  from 
the  effects  of  alcohol  are  partly  due  to  the  effect 
of  alcohol  on  the  circulation  and  the  injury  to 
the  blood  vessels,  thus  diminishing  the  nutrition 
of  the  brain  and  injuring  the  brain  tissue  itself, 
and  besides,  as  we  have  seen  in  other  viscera,  to 
the  increase  in  connective  tissue. 

It  is  not  necessary  here  to  go  into  the  details 
of  the  minute  formation  of  the  cells,  how  each 
cell  is  formed  of  a  cell  body  and  many  branches, 
as  one  may  conceive,  growing  like  a  tree  or  bush 
with  the  many  branches  stretching  out  and 
touching  other  branches  of  related  and  adjacent 
cells.  When  these  dendrites  or  branches  are  in 
contact,  there  is  an  interrelationship  between  the 
processes  of  the  two  cells.  Alcohol  causes  a  re- 
traction of  the  tiny  branches  one  from  another 
and  the  cells  are  dissociated,  so  that  the  men- 
tal processes  become  dissociated  from  each 
other,  and  the  cells  themselves  degenerate  and 
are  unable  to  carry  on  their  functions ;  thus  we 
see  the  functions  of  memory  and  of  the  repro- 
duction of  images  by  memory  prevented,  the 
inability  of  the  mind  to  reason,  through  the  in- 
ability of  the  mind  to  call  up  former  experiences, 


278  APPENDIX 

feelings  and  ideas,  and  a  weakening  of  the  power 
of  each  cell  to  take  in  impressions. 

Every  person  who  drinks  alcohol  to  excess 
will  not  show  every  form  of  mental  deterioration 
that  may  be  produced  by  excessive  indulgence, 
and  the  degree  of  deterioration  in  intelligence 
which  goes  to  make  up  the  sum  total  of  mentality. 
varies  greatly  in  different  individuals.  All  who 
drink  alcohol  to  excess,  however,  show  some 
diminution  in  their  judgment.  JudgTuent  means 
the  power  of  recalling  various  memories  of  per- 
ceptions through  the  senses,  which  have  come  in 
from  the  outside  world,  memories  of  ideas,  mem- 
ories of  emotions,  and  all  the  complicated  asso- 
ciation of  ideas  that  these  bring  up,  and  in  the 
recalling  of  them  weigh  each  one  with  the  other 
and  judge  of  the  value  between  them.  This  also 
means  reasoning  and  decision  for  action.  This 
power  of  reasoning  and  judging  is  weakened  in 
the  alcoholic,  and  in  any  brain  long  poisoned  by 
alcohol  it  is  an  impossibility  to  exercise  it. 
Memory  itself  is  also  weakened.  There  is  ex- 
cessive forgetfulness  of  the  recent  past,  and  in 
some  cases  of  advanced  alcoholism  there  is  abso- 
lute forgetfulness  of  wide  gaps  of  years ;  a  man 
m9,y  be  unable  to  remember  anything  from  the 
last  five  minutes  back  for  twenty  years,  and  then 


APPENDIX  279 

remember  back  to  childhood.  The  memories  of 
childhood  are  more  easily  stamped  on  the  brain 
than  are  those  of  adult  life,  both  because  it  takes 
less  to  impress  a  child,  and  because  there  is  not 
the  complexity  of  ideas  crowding  into  the  brain, 
nor  the  complexity  of  association  of  ideas  to  be 
recorded.  Therefore  memories  of  childhood 
make  a  deeper  impress  and  last  longer,  and  so 
the  complex  memories  of  the  adult  are  the  first 
to  be  forgotten  in  the  alcoholic,  and  those  of 
childhood  remain. 

EFFECT   UPON-   MEMOKY   AND   JUDGMENT 

Besides  the  absolute  forgetfulness,  there  is 
another  form  of  forgetfulness  in  the  alcoholic 
which  often  produces  a  ludicrous  result.  This 
is  a  perversion  of  memory.  The  person  may  be 
in  a  perfectly  strange  place  and  meet  strangers, 
and  yet  be  convinced  that  he  has  seen  the  place 
and  met  the  strangers  before,  and  greet  them  as 
old  friends.  This  feeling  of  having  been  there 
before  occurs  in  normal,  healthy  people,  and  may 
be  simply  the  expression  of  momentary  fatigue, 
or  proceed  from  some  unknown  cause ;  but  it  is 
grossly  exaggerated  in  the  alcoholic,  and  cannot 
as  easily  be  straightened  out  as  in  the  normal 
mind. 


280  APPENDIX 

The  imaginative  faculties  of  the  mind  are  at 
first  heightened  by  alcohol,  and  this  often  pro- 
duces bright,  witty  remarks  in  those  who  have 
taken  enough  alcohol  to  have  their  imaginations 
stimulated  and  their  judgment  shghtly  inhibited, 
so  that  their  ideas  crowd  readily  to  their  minds 
and  their  tongues  are  loosened.  Often,  how- 
ever, they  say  things  which  though  bright  and 
witty  had  better  be  left  unsaid,  and  this  is  an  in- 
dication of  the  beginning  paralysis  of  their  judg- 
ment. The  imaginative  faculties,  however,  are 
not  constructively  increased  by  alcohol,  and  it 
does  not  conduce  to  reproduction  and  creative 
ability,  which  requires  memory  and  constructive 
thought.  In  this  connection  Kraeplin's  experi- 
ments have  shown  that  alcohol  makes  easy  the 
liberation  of  movements  from  the  cortical  areas 
of  the  brain,  that  is,  the  transformation  of  ideas 
and  memories  of  movements  into  deeds,  but  no 
real  mental  power  is  given ;  for  while  a  man  may 
feel  that  he  is  doing  things  better  with  than  with- 
out alcohol,  as  a  matter  of  fact  he  is  not  doing 
them  so  well.  This  sense  of  self-approbation  is 
very  characteristic  of  the  alcoholic.  His  judg- 
ment is  gone,  not  only  in  regard  to  his  mental 
processes,  but  very  essentially  regarding  him- 
self, and  it  may  be  truly  said  that  while  alcohol 


APPENDIX  281 

shrinks  the  judgment,  it  swells  the  self-conceit. 
This  abnormally  good  opinion  of  his  diminished 
abilities  renders  the  alcoholic  exceedingly  com- 
placent ;  he  is  persuaded  that  at  any  time  he  can 
give  up  drinking  if  he  chooses,  and  he  is  unable 
to  appreciate  the  rapid  deterioration  of  his  intel- 
lect. One  cannot  separate  the  will  of  an  indi- 
vidual from  his  personality,  and  the  weak-willed 
individuals,  while  they  may  possess  many  other 
agreeable  characteristics,  are  lacking  in  the  pro- 
gressive force  which  strong  characters  possess. 
Alcohol  weakens  the  will,  causes  the  personality 
itself  to  deteriorate,  and  there  is  a  lack  of  initia- 
tive; there  is  the  ever  ready  specious  explana- 
tion why  nothing  is  ever  done ;  there  is  a  boast- 
ful conceited  estimation  of  what  can  be  done. 
With  the  judgment  perverted  the  alcoholic  can- 
not act  at  the  proper  time  in  the  right  way,  no 
matter  how  much  he  may  be  willing  to  admit  the 
necessity  for  correct  action,  and  on  the  other 
hand  he  is  equally  powerless  to  prevent  wrong 
action  on  his  part,  especially  when  such  action 
has  anything  to  do  with  a  further  indulgence  in 
his  alcohol. 

The  emotional  side  of  the  personality  shows 
the  same  deterioration  from  the  higher  to  the 
lower,  as  do  the  other  intellectual  processes.    It 


282  APPENDIX 

is  tlie  same  story  that  the  last  to  come  are  the 
first  to  go,  and  the  first  to  come  are  the  last  to 
go.  All  emotions  of  refinement,  those  of  the 
esthetic  development,  disappear  the  earliest. 
The  sense  of  affection  and  moral  responsibility, 
duty  to  family  and  friends  deteriorate  and  van- 
ish. There  is  nothing  left  but  the  consideration 
of  what  affects  the  self,  and  an  alcoholic  is  the 
most  studied,  selfish  soul  that  exists.  The  re- 
maining emotions  of  anger,  fear  and  nutritional 
reaction  for  food  and  drink  remain  to  the  last, 
as  these  are  the  most  primitive  of  the  emotions. 
With  the  weak  will  preventing  action,  and  with 
the  loss  of  memory  and  inability  for  continuity 
of  thought,  we  find  the  emotion  of  fear  predom- 
inating to  a  very  noticeable  extent.  This  is  true 
whether  the  alcoholic  be  delirious  or  not,  for  in 
all  forms  of  alcoholic  delirium,  fear  is  a  very 
predominant  symptom.  In  some  forms  of  de- 
lirium tremens,  the  intensity  of  the  fear  is  a  fair 
criterion  of  the  degree  of  the  poisoning.  The 
various  senses  of  sight,  hearing  and  taste  are 
dulled,  because  the  cells  producing  the  mental 
perceptions  are  equally  poisoned  with  the  rest 
of  the  mind. 


APPENDIX  283 

WEAKENING   THE   MOEAL  FIBER 

With  the  inaccuracy  of  sense  perception  and 
loss  of  memory  and  diminished  judgment,  one 
cannot  be  surprised  to  find  that  alcoholics  are 
notoriously  inaccurate,  unreliable  and  untruth- 
ful. They  cannot  tell  the  truth  even  with  assist- 
ance. But  often  what  is  credited  to  them  as  un- 
truthfulness is  mere  inability  to  perceive  things 
accurately,  to  remember  accurately,  and  there- 
fore to  state  things  accurately.  With  the 
deterioration  of  the  personality,  that  is,  of  the 
will,  one  would  naturally  expect  that  the  deteri- 
oration of  morals  would  go  hand  in  hand.  One 
cannot  remain  moral  or  virtuous  without  suf- 
ficient will  to  do  so,  and  without  sufficient  will  to 
make  a  struggle  for  self-control,  and  this  is  so 
in  the  case  of  a  mind  poisoned  by  alcohol.  I  do 
not  claim  that  lack  of  morals  is  a  disease,  but 
moral  development  has  appeared  late  in  the  de- 
velopment of  the  race,  and  such  racial  develop- 
ment is  expressed  by  the  individual.  With  the 
deteriorated  mentality  of  the  alcoholic,  we  must 
expect  that  the  characteristics  of  late  develop- 
ment will  be  the  first  to  go,  and  for  this  reason 
we  must  realize  that  alcoholism  naturally  tends 
to  immorality  and  crime.    As  a  matter  of  fact, 


284  APPENDIX 

it  is  claimed  that  fifty  per  cent,  of  the  crimes  in 
France  and  forty-one  per  cent,  in  Germany  are 
due  to  alcoholism,  and  no  doubt  in  England  and 
America  the  percentage  is  equally  high.  As 
might  be  expected,  the  offenses  are  principally 
those  of  disregard  of  the  rights  of  others,  con- 
tempt of  law  and  order,  assault,  disturbances  of 
domestic  peace  and  robbery,  and  to  all  these 
crimes  the  habitual  drunliard  is  particularly 
prone. 

But  it  is  not  my  purpose  to  discuss  the  effect 
of  alcohol  in  any  way  except  as  it  pertains  to  the 
human  body,  nor  to  go  into  the  reasons  why 
men  so  poison  their  bodies  as  to  bring  about 
these  deleterious  results.  The  deterioration 
that  we  have  been  considering,  when  occurring 
in  the  mind,  would  naturally  cause  one  to  infer 
that  insanity  must  also  be  common  in  those  who 
are  addicted  to  alcohol,  and  such  is  indeed  the 
case.  In  New  York  State  alone  I  believe  it  can 
be  safely  said  that  fully  ten  per  cent,  of  the 
women  and  thirty  per  cent,  of  the  men  confined 
in  the  state  asylums  are  there  through  forms  of 
insanity  caused  by  alcohol.  It  will  not  profit  us 
to  go  into  the  various  forms  of  alcoholic  insan- 
ity, but  when  we  realize  that  one-third  of  the 
men  in  the  insane  asylums  to-day  in  New  York 


APPENDIX  285 

are  there  because  of  excessive  indulgence  in  al- 
cohol, and  also  that  the  State  spends  annually 
over  six  million  dollars  to  care  for  them,  we 
reahze  both  the  terrible  ravages  that  alcoholic 
poison  has  made  on  the  mentality  of  men  and  the 
enormous  cost  that  it  entails  upon  the  conunu- 
nity. 

As  to  the  alcohol  circulating  in  the  blood, 
there  is  an  endeavor  naturally  to  get  rid  of  it  as 
with  all  poisons,  and  the  kidneys  in  this  en- 
deavor show  the  same  processes  that  are  else- 
where seen,  of  destruction  of  the  specific  cells, 
congestion,  and  increased  connective  tissue 
growth.  Whether  it  is  that  these  cells  are  de- 
stroyed in  an  endeavor  to  eliminate  various  sub- 
stances for  which  they  are  not  fitted  and  break 
down  under  the  strain,  or  whether  they  are  di- 
rectly poisoned  by  the  alcohol  itself,  the  result- 
ant factors  are  those  best  understood  in  the  lay 
mind  as  acute  and  chronic  Bright 's  disease. 
Whether  or  not  alcohol  produces  these  various 
processes  in  the  kidneys  which  result  in  these 
diseased  conditions,  there  is  no  question  but  that 
certain  of  these  diseased  conditions  appear  more 
frequently  in  alcoholics  than  in  others.  Besides 
the  destructive  processes  about  which  we  have 
been  speaking  in  the  various  viscera,  there  are 


286  APPENDIX 

certain  results  of  alcohol  that  may  Itie  said  to 
affect  the  general  condition  of  the  individual. 
By  this  I  mean  the  general  resistance  to  bac- 
terial infection,  the  resistance  to  injury  to  the 
body,  and  the  ability  to  repair  such  injuries. 
Alcohol  diminishes  the  power  of  the  body  to 
resist  bacterial  infection.  The  alcoholic  is  more 
prone  to  acquire  bacterial  diseases,  and  when 
these  are  acquired  he  is  infinitely  less  able  to 
resist  them.  In  Bellevue  Hospital  in  1904  there 
were  1,001  patients  with  lobar  pneumonia.  Of 
these,  667  gave  a  history  of  alcoholism ;  334  were 
non-alcoholics,  which  means  that  there  were 
twice  as  many  alcoholics  suffering  from  this  dis- 
ease as  non-alcoholics.  Among  the  alcoholics 
the  mortality  was  fifty  per  cent.,  and  among  the 
non-alcoholics,  23.9  per  cent.  Here  again  the 
mortality  among  the  alcoholics  was  more  than 
double  that  which  prevailed  among  those  who 
had  not  taken  this  narcotic.  The  same  is  true 
of  other  infectious  diseases.  When  injuries  oc- 
cur to  the  body,  such  as  broken  legs  or  arms, 
there  is  a  very  wide  difference  in  the  picture 
produced  in  those  who  have  drunk  to  excess,  and 
those  who  have  been  sober.  The  shock  pro- 
duced in  these  instances  is  greater  in  the  weak- 
ened nervous  system  of  the  alcoholic,  and  among 


APPENDIX  287 

those  who  have  habitually  taken  alcohol  there  is 
a  very  great  tendency  after  broken  bones  to  de- 
velop delirium  tremens,  and  when  this  occurs  in 
these  patients,  the  outlook  is  always  very  grave. 
A  broken  leg  or  arm  does  not  bring  with  it  any 
such  danger  to  those  who  have  led  sober  lives. 
The  process  of  recovery  from  disease  and  acci- 
dent, owing  to  the  deteriorated  nervous  system 
and  the  poisoned  circulatory  system,  is  much 
slower  in  alcoholics  than  in  others. 

WEAK   WILLS  INHEEITED 

Unfortunately,  the  injury  which  alcohol  does, 
and  the  processes  of  deterioration  which  it  sets 
on  foot,  do  not  end  with  the  individual.  Alco- 
hol poisons  and  injures  the  germ  cells  of  both 
sexes,  and  the  offspring  of  those  addicted  to  its 
use  may  inherit  a  weakened  and  injured  nervous 
system.  The  taste  for  alcohol,  the  craving,  so 
called,  is  not  inherited.  This  idea  that,  because 
a  man  has  an  alcoholic  father  or  mother,  he 
inherits  the  taste  for  alcohol,  is  a  superstition 
that  has  been  used  by  the  weak  as  an  excuse 
both  for  overindulgence  in  alcohol,  and  as  a 
further  excuse  why  no  attempt  should  be  made 
to  check  their  indulgence.  What  is  inherited  is 
a  weak,  unstable  intellect  and  personality,  prone 


288  APPENDIX 

to  excesses  in  all  things,  one  tliat  is  weak-willed 
and  weak  in  resistance  to  temptation,  and  one 
more  easily  affected  by  alcohol  than  the  ordi- 
nary normal  individual.  There  is  also  often 
inherited  a  lack  of  moral  perception  and  moral 
sense,  causing  the  individual  to  do  things  which 
make  one  doubt  his  sanity;  yet  he  can  not  be 
called  insane,  but  really  wanders  in  the  border 
line  between  mad  and  bad,  which  is  often  worse 
than  insanity  itself.  Alcoholic  inheritance  does 
not  stop  at  instabihty  of  the  nervous  system  or 
weakness  of  the  personality,  and  one  is  rather 
staggered  to  realize  the  high  percentage  of  im- 
becile, epileptic  and  weak-minded  children  that 
may  be  born  to  alcoholic  parents.  A  detailed 
study  of  the  imbecile  school-children  through- 
out all  Switzerland  showed  that  fifty  per  cent,  of 
them  were  bom  in  the  days  nine  months  after 
the  periods  of  greatest  alcoholic  indulgence, 
such  as  the  New  Year,  the  Carnival,  and  the 
grape  harvest,  and  that  the  births  of  the  other 
half  of  the  imbeciles  were  evenly  scattered 
through  the  remaining  thirty-eight  weeks  of  the 
year.  It  has  been  shown  that  in  France,  Ger- 
many, Poland  and  Switzerland,  from  twenty- 
eight  to  seventy  per  cent,  of  the  epileptics  in 
some  of  the  institutions  were  the  descendants  of 


APPENDIX  289 

alcoholics.  Demme,  in  comparing  the  results 
of  the  health  and  death  rates  between  ten  alco- 
holic families  and  ten  non-alcoholic  families, 
found  that  in  the  alcoholic  families  out  of  fifty- 
seven  children,  twenty-five  were  still-born  or 
died  in  the  first  month  of  life ;  twenty-two  were 
designated  as  sick,  and  ten  as  healthy  —  while 
in  the  non-alcoholic  families,  five  were  still-born 
or  died  early,  six  were  sick,  and  fifty  were 
healthy.  Thus  only  17.5  per  cent,  in  the  alco- 
holic families  were  healthy,  while  eighty-two 
per  cent,  in  the  non-alcoholic  families  were 
healthy,  and  only  eighteen  per  cent,  not  healthy. 
The  percentages,  therefore,  were  almost  ex- 
actly reversed.  These  statistics  mean  that  not 
alone  may  the  chronic  alcoholic  bequeath 
his  poisoned  nervous  system  to  posterity, 
but  from  the  statistics  in  Switzerland  of  the 
imbecile  children,  we  must  realize  that  even  a 
temporary  debauch  may  leave  a  curse  upon  the 
innocent  child ;  they  also  mean  that  alcohol  pro- 
duces those  processes  in  the  individual  which 
tend  to  the  degeneration  of  the  race,  and 
tend  after  a  few  generations  to  extinction,  and 
thus  does  Nature  benefit  the  race  by  turning  a 
curse  into  a  blessing  through  the  extinction  of 
the  degenerate. 


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